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OCT 1 1 1963 




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IN presenting this book to their patients the 
authors trust that it may be the means 
of spreading some useful knowledge of the 
dental organs and lead to a clue appreciation 
of the important function the teeth perform 
in the maintenance of health. A deplorable 
lack of information upon this subject is dis- 
played even by people who are otherwise well 
informed and who possess considerable general 
intelligence. Beyond the purely advertising 
pamphlet, the popular literature on the teeth 
is extremely limited, and it is hoped by the 
authors that the following pages will help to 
remedy the deficiency in this respect. They 
have endeavoured to give in as concise a 
manner as possible sufficient information to 
enable their readers to take reasonable care 
of their teeth and to recognize when it is 
desirable to consult a dental practitioner. In 
order to do this considerable prominence has 
been given to diseases of the teeth and gums 
and especially those arising from dental neglect, 
and from the presence of diseased and putrid 
roots in the mouth. 


Concerning the use of anesthetics in dentistry 
the authors have endeavoured to afford infor- 
mation which will prove of general interest, 
and regarding cocaine anesthesia they can 
fairly claim to speak with authority, as their 
experience in the use of this agent is very 

The chapter on hygiene of the mouth con- 
tains much information on the preservation of 
the teeth and on the course to be followed 
to render the mouth clean and healthy, to 
which are added some remarks on dentifrices, 

The concluding portion of the work re- 
ferring to artificial teeth should prove of service 
to those who are forced to adopt these useful 


London, E.C. 
May 1st, 1902. 



Introductory 9 

The Mastication and Insalivation of Food . . 14 

Food and Nutrition 23 

Food during Infancy in Relation to the Develop- 
ment of the Teeth 26 

First Dentition: the Temporary Teeth. . . 31 

Difficulties of the First Dentition ... 35 

The Care of the Temporary Teeth ... 38 

Second Dentition. Sixth-year Molar ... 41 

Troubles attending the Second Dentition . . 49 

Irregularity of the Teeth 51 

The Structure of the Teeth 67 

Decay of the Teeth 70 

Toothache and Neuralgia 78 

Toothache arising from the Inflammation of 

the Nerve of the Tooth (Pulpitis) ... 82 

Periodontitis and xIlveolar Abscess (Gum-boil) . 85 

Stopping or Filling the Teeth .... 92 

Tartar, or Salivary Calculus 97 

Extraction of the Teeth 101 

Painless Extraction of the Teeth by Nitrous 

Oxide Gas 103 

Use of Local Anesthetics in Dentistry . . 107 

Cocaine . .108 

Eucaine 112 

Ether Spray and Ethyl Chloride .... 112 
Difficulties and Complications in the Extrac- 
tion of Teeth 114 




Excessive Bleeding after Extraction . . . 118 

Pain after Extraction 121 

Necrosis 123 

Premature Loosening and Falling out of the 

Teeth . . 125 

Erosion of the Teeth 131 

Dental Hygiene 132 

Dental Dyspepsia 138 

Artificial Teeth : Historical Sketch . . . 141 

Prosthetic Dentistry 148 

The Adaptation of Artificial Teeth . . . 150 

The Construction of Artificial Teeth . . . 154 

Crown and Bridge Work. "American Dentistry" (?) 160 



IT is impossible to overrate the value of a 
good set of teeth even if their use in the 
mastication of the food is alone considered, but 
when in addition we estimate their services in 
assisting vocalization, and the necessity of their 
preservation in order to maintain the natural 
contour of the face, it is an obvious duty on the 
part of all to do their utmost to avoid those 
causes that lead to the premature destruction 
and decay of these useful organs. The preser- 
vation of the health of the mouth and teeth is 
essential to the general well-being. Disease of 
the body involves an unhealthy condition of 
the mouth, and is manifested by perceptible 
changes in the tongue, gum, lips, and mucous 

A diseased and unwholesome condition of 
the mouth cannot fail to act prejudicially on 
the bodily welfare. The pain and consequent 
loss of rest arising from decayed teeth are often 
very exhausting, and reduce seriously the vital 
energies. The loss of the power of mastica- 
tion directly affects the digestion, which is 
further impaired by the vitiation of the secre- 


tions of the mouth brought about by a con- 
gested and inflamed state of the gums. The 
constant swallowing of the purulent discharge 
produced by broken-down roots and decayed and 
abscessed teeth tends to irritate the stomach, 
while the air inhaled into the lungs is made offen- 
sive and is loaded with septic impurities which 
prevent it exercising its best influence on the 
delicate air cells of which these organs are built 
up, and on the blood which depends for its 
quality on the purity of the air respired. 

It is probable there has now been for several 
generations a progressive deterioration in the 
human dental outfit among civilized races. 

Structurally defective and decayed teeth 
and ill-developed jaws and irregular teeth are 
more prevalent, and the absorption of the 
sockets, recession of the gums, and consequent 
falling out of the teeth, more frequently met 
with long before the attainment of the period 
of middle age, instead of being practically un- 
known until an advanced age is reached. 

If this dental degeneration is to be success- 
fully combated, it must be not alone nor chiefly 
through the manipulative skill of dental opera- 
tors, but by a more thorough appreciation by 
the people of its causes and of the means by 
which they may be avoided. 

Matters of much less importance to personal 


appearance, of vastly less account to individual 
comfort, and of far smaller moment to health 
and life, are made the subjects of constant 
study and care, while the teeth are utterly 
neglected until disease and decay have so far 
progressed that their extraction is the only 
possible treatment. 

Patients defer consulting a dentist until their 
mouth is in an almost hopelessly diseased state, 
their gums inflamed and irritated by a number 
of ulcerated roots, and possessing only decayed 
teeth with large cavities in which decomposing 
food remains for weeks and months, rendering 
the breath unbearably offensive. Neuralgic 
pains, abscesses, diseased jaws, with disfiguring 
wounds on the face and neck, dyspeptic troubles, 
tumours, and abnormal growths of various 
kinds, and protracted diseases of the nose, 
ears, throat, and eyes, are often the result of a 
neglected mouth and diseased teeth, although 
the true cause of such diseases may be fre- 
quently overlooked both by the patient and his 
medical adviser. 

It is absolutely true, as a writer in The 
British Journal of Dental Science of October 
15th, 1901, remarks that : — 

" Hundreds and thousands of people are 
going about with decayed teeth, carrying with 
them so many small cesspools in their mouths, 


filled with fetid abominations of putrid food 
debris, with its teeming population of micro- 
organisms, daily swallowing these putrefac- 
tions, and absorbing the pus. Many cases 
of septic diseases are due to dental caries. 
Its effects may be manifested in multifarious 
ways. Many of the so-called ' scrofulous ' 
scars of the neck have had their starting point 
in carious teeth. The usual complaint by 
patients that fresh air will give them face ache 
is in most cases due to uncared-for carious 
teeth. Many laryngeal and pharyngeal (throat) 
troubles have their origin in the same cause. 
A man with a decayed molar hardly ever has a 
clean tongue." 

The Journal of the British Dental Associa- 
tion, commenting upon the annual conference 
of the " Health Society," remarks : — 

" The subject of ' health ' can hardly be 
adequately discussed without a certain amount 
of attention to the dental aspect of the 

" We believe half of London to be rendered 
unhealthy for the want of systematic instruc- 
tion in dental sanitation. Hundreds 'of thou- 
sands of people go about night and day 
creating insanitary conditions by means of 
emanations from decaying stumps, chronic 
abscesses, inflamed gums eaten into by tartar, 



and last — not least — the noxious gases formed 
in the stomachs of those unfortunates who, 
destitute of proper masticatory apparatus, 
cannot digest their food. 

" The poor and dirty dwellers in the slums 
have much to learn concerning health and 
sanitation, and no doubt simple and long- 
established axioms will require much demon- 
strating and explaining before they are brought 
home to the dregs of the population, and the 
general ignorance about the teeth would form 
a capital subject for an energetic and en- 
thusiastic philanthropist. 

" We all know what the results of tartar are, 
yet we would venture to say that tartar exists 
to a very detrimental extent in the purlieus of 
London in the mouths of the uncleanly poor, 
and thereby not only they themselves are 
injured in health, but the very air is rendered 
less fit for respiration and a more efficient 
medium for the spread of disease. 

" The effect may be seen in the greeny- white 
faces, the dwarfed stature, sunken chests, sore 
eyes, and rickety limbs, that people these 
districts. The boon of model dwellinghouses 
might with advantage be combined with the 
introduction of tooth brushes, and instruction 
how to use them. 

"If the lowest strata of society could be 


restored to the blessings of cleanliness and a 
good digestion, many grievances would disap- 
pear of themselves, and the life of London 
wonld be healthier and happier. 

"We wonld urge, then, upon the consideration 
of the Health Society that their scheme is 
imperfect if the mouth — the greatest factor in 
the relative impurity or purity of the body — is 
allowed to remain in an unwholesome con- 

Mastication and Insalivation of Food, 

GrOOD health demands thorough digestion : 
thorough digestion demands thorough masti- 
cation, and thorough mastication demands 
sound and healthy teeth. Ulcerated roots and 
decayed teeth, an inflamed mouth and vitiated 
saliva, are poorly fitted to supply the stomach 
with food that can be properly digested and 
assimilated. An eminent writer, speaking upon 
this subject, says : — 

" The stomach may be compared to a stove : 
the food to the fuel consumed by the stove, 
and life to the heat given off by the glowing 
coals. The stomach is an excellent stove and 
will burn much bad fuel ; but have a care 
lest it rebel and the fire be extinguished." 

To maintain a vigorous and sustained vital 


glow, a suitable aliment must be supplied and 
it must be thoroughly ground by the teeth 
and moistened by the fluid called the saliva, 
which is the first of the digestive fluids that 
the food meets in its progress through the 
body. The introduction of food into the 
mouth results in the discharge from a number 
of glands of an increased quantity of saliva 
which, mixing with the food, assists the teeth 
in reducing it to a fit condition for the digestive 
organs to continue the work of breaking it up, 
separating and assimilating its nutritive con- 

The saliva is secreted by three pairs of 
glands placed symmetrically on the right and 
left sides of the mouth ; these are the parotid 
glands which are situated immediately below 
and in front of the ear, the sub-maxillary 
glands, which are placed under the angle of the 
lower jaw, and the sub-lingual glands which 
are found under the tongue in the fleshy part 
of the mouth. All of these glands communi- 
cate with the mouth by special conduits or 
ducts, those of the parotid, known as Steno's 
ducts, opening inside the mouth, immediately 
opposite the second molar teeth, while the sub- 
maxillary and the sub-lingual have their outlets 
in the floor of the mouth beneath the tongue. 
The secretions of the various glands differ : that 


of the parotid is most abundant and is a clear 
and limpid fluid. Its principal function is to 
moisten the food and reduce it to the required 
consistency. The thick ropy fluid secreted by 
the sub-maxillary gland promotes the solution 
of the soluble substances and specially impresses 
the nerves of taste, while that of the sub-lingual 
gland lubricates the food and facilitates its 
passage down the pharynx. The parotid glands 
are the chief source of the moisture that flows 
into the mouth during continuous speaking; 
and when inflamed they constitute the disease 
known as mumps. 

The numerous mucous glands which exist 
in the floor and roof of the mouth, tongue, 
gums, and cheeks also add their quota to the 
moisture of the mouth ; they secrete a some- 
what turbid slightly viscid fluid having a faint 
acid reaction (mucus). 

The mixture of all these secretions consti- 
tute the saliva, which is a thick, glairy, gener- 
ally frothy and slightly turbid fluid consisting 
of about 99 per cent of water. Its reaction 
in health is alkaline, especially when the secre- 
tion is abundant. Saliva contains but few 
solids; of these about half consist of salts and 
half of ptyalin and other organic principles. 
Ptyalin is the active principle of the saliva, 
which plays an important part in digestion ; 



it has the power of converting starch into 
grape sugar, which is the first step in a series 
of chemical processes (digestion) by which the 
food is prepared for the uses of the economy. 
That the action of the saliva upon starchy 
foods is of great importance becomes ap- 

Fig. 1. — Dissection showing position of Saliva Glands. 

1. Parotid (near the ear). 

2. Duct of Steno (leading from parotid gland to mouth). 

3. Sub-maxillary gland (beneath the jaw). 

4. Duct of sub-maxillary gland. 

5. Sub-lingual (beneath the tongue). 

parent when it is understood that starch 
as such is insoluble and would therefore be 
not only valueless as nutriment but a posi- 
tive burden to the digestive organs, while 
the sugar into which it is converted by the 
saliva is readily soluble and nutritious. The 


quantity of saliva discharged into the mouth 
varies with the condition of the food introduced, 
being abundant in proportion to the dryness 
of the food. Its secretion varies also with 
the varying health of the body. It is much 
diminished and sometimes almost suspended 
by fear, anxiety, or other depressing emotions. 
In diseased conditions of the general system 
its character is variously modified, becoming 
acid or excessively alkaline ; acting upon the 
soft tissues of the mouth, causing soreness and 
ulceration, and upon the teeth, causing their 
disintegration. Thus it often happens that 
during a severe illness very serious inroads 
are made upon the integrity of the structures 
of the teeth which are attributed frequently 
and erroneously to the medicine taken. 

The acts of mastication and deglutition are 
more complex than they at first sight appear. 
The food, first divided into pieces of suitable 
size by the front teeth, is passed back to the 
molars, which by their grinding action rapidly 
convert it into a pulpy mass. The tongue 
and cheeks participate by passing the food 
backward and forward over the grinding sur- 
faces of the teeth, and preventing any portion of 
it escaping titeration. Having been sufficiently 
masticated the food is rolled into a rough bolus 
or ball by the tongue, lubricated by the saliva, 



and is passed backward towards the gullet or 
esophagus. The processes up to this point 

Fig. 2. — Diagram of Food and Air Tracts. 
The solid line through, mouth and gullet represents the 
course taken by food and drink ; the dotted lines through 
mouth, nasal passages, and air-tube represent the course taken 
by the air. 

have been voluntary, dependent on the will, but 
as the food reaches the gullet an involuntary 
muscular action is excited and the food is seized 


and passed downwards into the stomach by 
muscles which act independently of the will. 
Nearly all the muscles of the esophagus, 
stomach and the intestines are of this nature. 
They are excited to activity by the presence of 
food, and their movement is in no way depen- 
dent on volition. 

The stomach is a pear-shaped muscular bag 
lined, like the mouth, with mucous membrane. 
It receives the food from the esophagus near 
the middle of the smaller or upper curve, at 
the largest diameter of the organ, and dis- 
charges into the intestines at its smallest end 
through an aperture known as the pylorus. 
The stomach is furnished with a number of 
glands which, when excited by the presence 
of food, secrete the fluid known as gastric 
juice. Pure gastric juice consists of a small 
quantity of saline matter in solution. It is 
acid owing to the presence of a small per- 
centage of free hydrochloric acid, and con- 
tains in addition an active principle known as 
pepsin. This pepsin has the power of break- 
ing up and dissolving proteid or flesh-forming 
matters consumed as food, such as the lean of 
meat, the gluten of flour, the casein of milk 
and cheese, the albumen of eggs, etc., and a 
large proportion of these substances thus dis- 
solved is absorbed directly into the blood, 



through the walls of the stomach ; but the 
greater bulk of the aliment, reduced to a con- 

Fig. 3. — Diagram of Alimentary Tracts. 

1. Lower end of esophagus. 

2. Stomach. 

3. Duodenum opening from pylorus. 

4. Jejunum or small intestine. 

5. Ascending, transverse, and descending, colon (large intestine). 

6. Csecum with vermiform appendix. 

7. Rectum. 

sistency resembling pea soup by the combined 
action of the gastric juice, and the constant 


churning produced by the muscular con- 
tractions of the stomach, pass through the 
pylorus into the duodenum or small intestine. 
It is there mixed with the pancreatic juice, 
discharged from the pancreas or sweetbread, 
a strongly alkaline fluid which completes the 
work of the saliva, converting that portion of 
starch which has escaped the action of the 
ptyalin into sugar, and emulsifying the fatty 
matter of the food, reducing it to somewhat 
the same state as the fat, i.e. the butter, as it 
exists in milk. It also assists the stomach in 
the digestion of such proteid matters that have 
left that organ insufficiently digested. A great 
deal of the digested food is taken up by vessels 
called the lacteals that enter into the walls of 
the small intestines, and passed into the general 
circulation where it nourishes and builds up the 
tissues of the body. The digested food, nearly 
deprived of its nutrient matter, passes from 
the small into the large intestines where the 
absorption of the surplus water and the small 
remaining portion of useful constituents take 
place. The coloid or indigestible matter is 
passed on to the rectum and finally discharged 
from the body. It will thus be seen that in 
the mouth the amyloids or starchy matters are 
acted upon, and in the stomach the proteids 
are alone digested, while in the small intestine 


both these, with the addition of fatty matters, 
are thoroughly digested, and adapted to supply 
the needs of the system. 

Food and Nutrition. 

Chemical analysis shows of what substances 
the body is composed; and while an examination 
of the excretions demonstrate that all of such 
substances waste in greater or lesser degree, 
the deficiency occasioned by this waste has to be 
made good by the food consumed. To maintain 
that state of functional activity known as health, 
the food must contain these particular sub- 
stances in such a form that the body is able 
to digest and assimilate them. The mineral 
world can supply all the elements which enter 
into the construction of the human body, but the 
system is unable to utilize them and to build 
up its organic constitution from non-organized 
elements. The plant is the alembic through 
which the mineral passes to adapt it to the 
needs of the animal economy. 

From the soil, the rain and air, under the 
stimulus of the light and warmth of the sun, 
the plant builds up these complex combina- 
tions of the elementary substances that feed, 
sustain, and nourish the animal kingdom. Man 
can live and maintain his health on a diet 


derived entirely from the vegetable world, or 
entirely from the animal kingdom ; but experi- 
ence shows that in the temperate zone, at least, 
a mixed diet is the most suitable. 

The most perfect diet is one which gives the 
whole of the required constituents of the body 
in the right proportions and in an easily digest- 
ible form, and which contains a sufficient per- 
centage of inert or indigestible matter to give it 
bulk and stimulate the bowels to healthy action. 
The latter ingredient is necessary, as absolutely 
digestible and concentrated food stuffs produce 
constipation. A man can live on wheaten flour 
alone, as it contains all that is necessary to 
support life, but he would starve on a diet com- 
posed of arrowroot, sugar and fat, as effectually 
as he would if deprived of food altogether. 

The reason of this is that while such a diet 
would afford the carbon, hydrogen and oxygen 
required as food, it would be totally lacking in 
the nitrogen which builds up the muscles and 
other tissues of the body. Vegetable foods with 
few exceptions are poor in nitrogenous or flesh- 
forming constituents, but rich in starch and 
sugar, known as amyloids or heat and force 

Nitrogen is found in the most easily digested 
form in the flesh of animals ; thus a properly 
mixed diet affords the^ required proportions of 


carbonaceous and nitrogenous constituents in 
due proportions, and the diet universally 
adopted in the temperate zone is economically 
and physiologically the most suitable to human 

The cereals and the pulses are compara- 
tively rich in flesh formers, but in the latter 
case the nitrogen exists in the form of vegetable 
casein, which is difficult to digest, and probably 
with delicate stomachs escapes digestion alto- 

The cereals afford nitrogen as gluten, which 
is easily digested, but even with wheat, the most 
highly nitrogenized of all, the proportion of 
starch is considerably in excess of that required 
by the system. Wheaten flour as usually sup- 
plied contains 10*8 per cent of nitrogenous 
matter accompanied by 72*5 per cent of starchy 
or heat producing constituents. 

A slight deficiency in the supply of certain 
necessary elements in the food does not neces- 
sarily mean death, but this deficiency is sure to 
be reflected in the health and development of 
the individual. 


Food during Infancy in relation to 
the Development of the Teeth. 

The muscles, mental and nervous capabilities, 
the bones and teeth, all suffer from an insuffi- 
cient or unsuitable diet, especially during the 
period of infancy/ The body loses its power of 
resisting disease, the bones are frail, and the 
child becomes ricketty ; the teeth are soft and 
deficient in their mineral constituents, and are 
lost early from decay. A common error is to 
give infants and young children a diet contain- 
ing far too great an excess of starchy matter. 
Cornflour and arrowroot contain nothing for 
making bone and muscle, while very young 
children are quite incapable of digesting starchy 
foods at all. Were it not that these foods were 
generally prepared with milk the child would 
absolutely starve on them. And the nutrient 
value of the milk is absolutely lessened by the 
addition of these substances during the first ten 
months. Both the temporary teeth and crowns 
of the permanent teeth are formed during the 
first two years of life, and it is during this 
period that the most serious errors are made 
in the feeding that result in the lamentably 
faulty dentures we see in after life. The proper 
food during the first period of infancy is that, 


and that only, which has been provided by 
Nature for the young of mammals, viz. milk. 

General observation and carefully collected 
statistics agree in conclusively showing that 
nothing can adequately replace this natural 
food. " The infant," says Dr. West, " whose 
mother refuses to perform towards it a mother's 
part, or who by accident, disease or death is de- 
prived of the food that Nature destined for it, too 
often languishes and dies. Such children you 
may see with no fat to give plumpness to their 
limbs, no red particles in their blood to impart 
a healthy hue to their skin : their face wearing 
in infancy the lineaments of age, their voice a 
constant wail, their whole aspect an embodi- 
ment of woe. But give to such children the 
food that Nature destined for them, and if the 
remedy does not come too late to save them the 
mournful cry will cease, the face will assume a 
look of content ; by degrees the features of in- 
fancy will disclose themselves, the limbs will 
grow round, the skin pure red and white, and 
when at length we hear the merry laugh of 
babyhood, it seems almost as if the little 
sufferer of some weeks before must have been 
a changeling and this the real child brought 
back from fairyland." 

Formed for the special purpose of constitu- 
ting the sole nourishment during the first period 


of infantile life, milk not only contains the 
principles required for the growth and main- 
tenance of the body, but contains them under 
such a form as to be specially adapted to the 
feeble digestive powers then existing, which 
show a great want of the power of adaptive- 
ness to alien articles of food. The teeth, which 
about this time begin to show themselves, indi- 
cate that preparation is now being made for 
the consumption of food of a solid nature, and 
the most suitable to begin with will be one of 
the farinaceous products. Bread, baked flour, 
biscuit powder, oatmeal, or one of the numerous 
kinds of nursery biscuits that are made may be 
employed for a time as a supplement to the 
previous food ; then, at about the tenth month, 
the maternal supply, which should have been 
already lessened, should be altogether stopped, 
and the child started upon the life of indepen- 
dence that is to follow. For a while milk and the 
farinaceous products referred to above, with the 
addition of broth and beef tea, form a most 
suitable diet, but as the child advances towards 
its second year and the teeth become more 
developed, meat should be added. 

Dr. W. B. Cheadle, Physician to the Hospital 
for Sick Children, Grt. Ormond Street, says : l — 
" I would insist that children are naturally 
1 The Book of Health (Cassell & Co.). 


animal feeders in early years. The children 
fed on animal food are most robust, and that 
for them to obtain perfect development they 
must be supplied with a sufficient amount of it. 
If milk be taken freely and well digested that 
is usually sufficient ; but if not, its place cannot 
be supplied satisfactorily by any vegetable 
material. Some other animal food such as 
beef tea, meat, or eggs, is the essential sub- 

" As a matter of fact, children do not very 
often suffer from any excess of animal food. 
Occasionally meat given in excess disorders the 
stomach or sets up gravel ; but this only hap- 
pens when it is taken too freely in addition to 
other animal food such as milk, eggs and butter. 
In truth, far greater danger lies in the other 
direction. After the first year the child begins 
to take bread and butter and biscuits ; these 
articles of food are convenient and handy : the 
child likes them, and before long, perhaps, 
bread and biscuit become the staple of its diet, 
to the exclusion of a full proportion of animal 
food. It gets bread and butter and a little 
milk for breakfast, and a biscuit for luncheon ; 
dinner, perhaps, comprises some meat or beef 
tea and pudding, while tea and supper consist 
of bread with treacle or jam, or butter, and a 
small quantity of milk only to drink. Thus 


the child, though feeding well, grows soft in 
muscle, soft in bone, fragile of tooth, and back- 
ward in teething, which proves irritating, slow 
and painful." 

It often happens, through natural causes 
or from the exigencies of social life, that the 
mother is unable to give the requisite supply 
of milk. In this case, next to a healthy wet 
nurse, a liberal supply of good cow's milk 
(boiled) is the best substitute ; to render it 
more nearly identical with the human milk 
it should be diluted by the addition of one- 
third of water and a small tablespoonful of 
white sugar (about half-ounce) added to the 
pint. Later on the dilution may be diminished. 

The importance of securing as far as prac- 
ticable that the milk is derived from an animal 
in a healthy state and surrounded by whole- 
some conditions, will be readily understood. 
The alimentary canal of infants, and particu- 
larly of some, is exceedingly impressionable to 
unwholesome food ; and the milk of cows kept, 
as cows in large cities and towns not un- 
frequently are, in an unnatural state, may 
prove the source of violent irritation of the 
stomach and bowels, and lead, if persisted in, 
to serious impairment of the health, terminating 
ultimately, it may be, in a fatal result. There 
can be little doubt of the desirability of always 


obtaining the supply from the same animal 
instead of indiscriminately from any cow, and 
arrangements for this are generally made in 

First Dentition : 

The Temporary Teeth. 

Man, of all animals the most dependent upon 
his own species, is not as a rule furnished with 
any teeth until nearer the end than the com- 
mencement of the first year of his existence, 
and the process has seldom terminated much 
before manhood is attained. During the period 
between birth and the possession of a sufficient 
number of teeth to render the individual inde- 
pendent of the mother, it is supplied with a 
food in form and composition the most suitable 
to its requirements, viz. a bland palatable 
fluid holding in solution all the constituents 
out of which its various tissues can be nourished 
and developed. Contemporaneously with the 
development of the teeth other organs are also 
becoming developed, whose function will be 
necessary when the former are so far advanced 
as to enable the individual to obtain its food 
from other sources, and which, being of a less 
simple form and character, will require more 
complicated processes to bring it into a con- 


dition in which it can be assimilated and turned 
to the same account. 

This period of development is one fraught 
with danger to the child, as a large percentage 
of infant mortality can be traced directly or 
indirectly to the constitutional disturbances 
that attend dentition. 

The temporary teeth in man are twenty in 
number — ten in the upper and ten in the lower 
jaw. The order and period in which they are 
erupted are subject to great variation. 

Teeth may be erupted at or even prior to 
birth, or they may not appear until the second 
year has been completed, but in the healthy 
individual we may look for the lower central 
incisor making its appearance at the com- 
mencement of the eighth month, and being 
joined by its fellow a week or two later. 

After an interval of two or three months the 
central incisors of the upper jaw appear, fol- 
lowed from within a month to six weeks by the 
lateral incisors of the same jaw. 

The lower lateral incisors generally appear 
next in order ; thus the child at the completion 
of its first year has eight teeth through the 
gums. Within another period of two months 
the four first molars will appear. These are 
erupted at the back of the jaw, leaving a space 
between them and the lateral incisors. At the 


expiration of a further four or five months this 
space is occupied by the canines appearing. 
The eruption of the second molars shortly after 
the second year completes the temporary set. 

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Fig. 4. — Illustrates the Temporary Teeth on the left side. 

1-1. Central incisors. 
2-2. Lateral incisors. 
3-3. Cuspids or canines. 
4-4. First or anterior molars. 
5-5. Second or posterior molar. 

The order of eruption of temporary teeth is 
tabulated by Coleman as under — 

Group. Months. 

1. Lower central incisors .... 7 
Duration of eruption one to ten days. 
Pause two to three months. 



Group. Months. 

2. Upper central and lateral incisors . . 9 

Duration of eruption four to six weeks. 
Pause two months. 

3. Lower lateral incisors . . . .12 
First molars ...... 14 

Duration of eruption one to two months. 
Pause four to five months. 

4. Cuspidati (canines) . . . . .18 

Duration of eruption two to three months. 
Pause three to five months. 

5. Second molars ...... 20 

Duration of eruption three to five months. 

Fig. 5. 
Diagram showing the two sets of teeth (temporary and per- 
manent) in the jaws of a child of six years. Sixth-year molars 
are already in position, the rest of the permanent teeth in vari- 
ous stages of development. 


Difficulties of the First Dentition. 

Under the most favourable circumstances 
the teeth may appear one after another at the 
usual time, with so little apparent disturbance 
to the individual, that their presence may be 
only accidentally discovered. 

In many cases, however, the condition of 
matters is not so favourable. For some time 
previous to the eruption of each tooth the 
child becomes fretful and irritable, and the 
gums appear hot and swollen and tender ; the 
rubbing, evidently hitherto grateful, now causes 
pain and resistance. 

Diarrhea, the result of intestinal irritation, is 
not uncommon. A troublesome cough, likewise 
the result of irritation conveyed to the respi- 
ratory tract, often sets in with the eruption 
of each tooth and, like the diarrhea, ceases 
when the tooth has become erupted. Eruptions 
are apt to appear usually on the cheek, but 
sometimes on the head or even over the whole 
body, and ulceration on the gums, lips, or on 
the inside of the cheeks, uneasiness and fret- 
fulness, restless sleep or wakefulness, thirst 
and loss of appetite are evidences of increased 
constitutional disturbance, which if not relieved 
culminate in copious and persistent diarrhea, 
high fever, convulsions, and perhaps death. 



Considerable relief is often afforded to the 
little sufferer by lancing the gum over the 
erupting tooth or teeth, the slight loss of blood 
diminishes local inflammation while the division 
of the tissues reduces the resistance that the 
tooth meets in piercing the gum. Severe con- 
stitutional symptoms frequently rapidly subside 
on the performance of this operation, but to be 

Fig. 6. 
Showing direction of Incisions made in Lancing the Gum. 

effectual and to thoroughly relieve the tension 
of the gum, the cut should be made with 
special reference to the form of the coming 

The molars require a crucial incision. In 
the case of either of the incisions, superior or 
inferior, owing to their straight edges the 
slightest appearance of the tooth through the 
gum gives entire relief so far as that particular 
tooth is concerned. Not so, however, with the 
cuspids and molars. The cuspids, it will be 
remembered, have cone-shaped crowns, and 



therefore, even after the eruption of the points, 
still keep up the pressure by reason of the 
inclosing ring of gum. A complete severance 
of this ring on the lateral surfaces, as well as 
on the anterior and posterior faces, is necessary 
to relieve the tension. So all the cusps or 
points of a molar tooth may have erupted and 

v \ X //> 

Fig. 7. — Lancing the Gum. 


yet bands of gum tissue around and between 
them maintain a resistance as decided as before 
their appearance, but which is entirely over- 
come by cuts. 

If after lancing the cuts should heal before 
the tooth is fairly through the gum, the opera- 
tion should be repeated as often as is neces- 

Sometimes, but not often, there is a little too 
much bleeding, generally caused by the child 
sucking the gums, incited thereto by the taste 


of the blood. In such case the substitution of 
the breast of the nurse will give the infant 
better employment. 

The care of the Temporary Teeth. 

The temporary teeth are liable to the same 
causes of decay as the permanent ones, and 
equal care should be taken of them. It is 
really astonishing how little attention is gener- 
ally paid to them, the prevailing idea being that 
as they are destined soon to be lost and give 
place to the second set, it is unnecessary to 
attempt to preserve them. 

This argument as to their loss and replace- 
ment is indeed true, but other things of greater 
importance should be taken into consideration. 
The hopes of the parents are that the anticipa- 
ted set will be placed evenly and beautifully in 
the dental arches so that no deformity may 
exist : that no crowded teeth will have to be 
extracted : that no tedious operation for regula- 
ting will be necessary, and that there may be 
no unusual liability to decay. 

The surest way to secure the disappointment 
of all these commendable hopes is to be negli- 
gent in regard to the preservation of the decidu- 
ous teeth. It is not the design of Nature that 
the first set shall be lost by the destruction of 


the crowns, but by the destruction of the roots. 
Take care of the crowns and the roots will take 
care of themselves. 

It is intended that simultaneously with the 
advance of the permanent tooth, the absorption 
of the root of the temporary tooth should occur, 
so that when the temporary tooth is thus 
loosened, the permanent one is generally close 
at hand to occupy its place. Thus no loss of 
space results, while it would be different if the 
milk teeth should be extracted months or years 
too soon; for any one, who has examined at all, 
has noticed that when a tooth has been lost and 
nothing has occupied the space there has been 
a tendency of the teeth to lean toward each 
other on the sides of the vacancy. Where then 
there is this diminution of space, it is impossible 
for the second teeth to arrange themselves 
regularly ; there is barely enough room under 
the most favourable circumstances. Irregularly 
placed teeth are unusually liable to decay, both 
from the great difficulty of properly cleaning 
them, and from the fact that when such portions 
of enamel touch each other, as are not intended 
to be in antagonism, injury results. How then 
can the temporary teeth be preserved ? The 
teeth should be cleaned several times daily by 
the parent when the child is too young to do it, 
and by either when the child is old enough. 


There are occasionally cases in which the in- 
structions herein given will not hold good, but 
their occurrence is so infrequent that they may 
be regarded only as exceptions. For instance, 
sometimes the process of absorption in the roots 
of the temporary teeth fails to be brought 
about, and the permanent teeth erupt in front 
of or behind them : in which case, of course, 
the solid temporary teeth must be extracted. 
Anomalies, connected with the relationship of 
teeth to the jaws and of the jaw r s to one 
another, occasionally present themselves, which 
should be made the subjects of careful study 
and good advice before determining what course 
to pursue. 

The teeth should be frequently examined by 
the dentist and, if decay or such imperfections 
in the enamel as would lead to decay should be 
found, the places should be filled. 

If the child should be too young to undergo 
the more tedious operation of filling with gold, 
there are various fillings which are put in a soft 
state and subsequently harden, that preserve 
the teeth sufficiently well. Besides the advan- 
tages before alluded to accruing from the pre- 
servation of the deciduous teeth, it certainly is 
not the height of parental kindness to allow 
children to suffer the agonies of toothache when 
it can be avoided ; nor is it wise to allow their 


early visits to a dentist to be for the pur- 
pose of having their teeth extracted, for often 
such a lasting unpleasant impression is made 
that in after years they will suffer their teeth to 
go to destruction rather than go near the places 
that are surrounded with such unpleasant 

Second Dentition. 

Sixth=year Molar. 

The eruption of the second set begins before 
any of the first teeth are shed. Between five 
and a half and six and a half years of age the 
first permanent molars, four in number — one 
on each side of the upper and lower jaws — 
make their appearance. These are commonly 
supposed by parents to belong to the first set, 
and therefore, if found decayed shortly after 
their eruption, no attention is paid to them, 
because it is thought that they will soon have 
to make room for their successors, and before 
the error is discovered the mischief is irrepar- 
able. The sixth-year molars are the largest 
teeth in the mouth. In Figs. 8 and 9 they 
are shown in their relation to the temporary 
set — in a child of about six years of age. 
In Figs. 10 and 11 these same teeth are 
illustrated in their relation to the permanent 


set. They are very important teeth in many 
respects, and should never be allowed to suffer 

6 w 

Fig. 8. — Upper Temporary Set of Teeth with the sixth-year 
Molar in position (6 6). 

Fig. 9. — Lower Temporary Set with sixth-year Molar in 

position (6). 

from decay if by any possibility it can be 
avoided. Even if they cannot be permanently 



saved there are good reasons, with reference to 
the preservation of the integrity of the arch, 
why they should be retained up to a certain 

Fig. 10. 

period, viz. to that between the tenth and 
twelfth years — the time when the twelfth-year 
molars are about to appear, and there are 
equally good reasons why, if they cannot be 
retained with a fair prospect of their permanent 
preservation, they should be extracted at that 
particular time. 

Another fact which should make each one 
of these teeth the object of special anxiety 
on the part of the parent is that, in the 
opinion of many practitioners of ripe experi- 



ence, the loss of one frequently necessitates 
the removal of all four in order to preserve the 

Fig. 11. — Side view of an adult lower jaw. 

harmonies of articulation. It is a good rule for 
parents to count their children's teeth occasion- 



ally after the fifth year, and when more than 
five are found on either side of either jaw they 
may know that the sixth or last one belongs to 
the second or permanent set, and if lost will 
never be replaced ; that if extracted except at 


i i 





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Fig. 12.— Permanent Teeth of the' Left Side. 

the exact time when the conditions are most 
favourable, the results may be disastrous to the 
entire denture, more or less interfering with 
comfort and health, and by the consequent pre- 
vention of perfect mastication leading to dys- 

4 6 


peptic and intestinal derangements, tending to 
shorten life. 

The want of a proper appreciation and proper 
treatment of these sixth-year molars is, it is safe 
to say. one of the most fruitful causes of the 

Fki. 13.— Side View and Masticating Surfaces of the 
Permanent Teeth. Upper Jaw. 

defective masticatory apparatus of a vast ma- 
jority of people at and beyond forty years of 
age. As the permanent teeth approach their 



full development a process called absorption is 
set up, by which the roots of the temporary set 
are gradually removed. Little by little the 
roots are dissolved and the particles composing 
them are carried away, until only the crowns 

Fro. 14. — Lower Jaw. 

remain. This absorptive process does not begin 
upon the roots of all the temporary teeth at 
once, but in the order corresponding to their 
development and eruption. The lower central 
incisors are the first to become loose and fall 
out ; then the upper central incisors : then the 

4 8 


laterals, and so on in tlie order in which they 
appear. Deprived of their support in the 
sockets, and retaining only a slight attachment 
to the gums, the crowns are pushed out by the 
movements of the tongue, cheeks or lips during 
mastication, or are picked out with the 

The second or permanent teeth are thirty- 
two in number, including twelve not found in 
the temporary set, viz., eight bicuspids and four 
wisdom teeth. The following table gives the 
average time and order of eruption of the per- 
manent teeth, liable however, both as to time 
and order, to very considerable variation in 
exceptional cases — 





jaw (1) 



First Molars (6) . 
) Central Incisors, lower 
\ Central Incisors, upper jaw (1) 

Lateral Incisors, both jaws, lower 
preceding upper (2). 

First Bicuspids (4) 

Second Bicuspids (5) 

Cuspidati, or Canines (3) 

Second Molars (7) 

Third Molars (8) . 

The numbers in brackets will serve to identify the form 
aud position of these teeth b}^ referring to Figs. 10, 11 
and 12. 



17 to 20 


Troubles Attending the Second 

The second dentition is accomplished under 
much more favourable conditions than the 
first, when the nervous apparatus is under- 
going a condition of development incompar- 
ably greater than appears at any other period 
of life ; but it occasionally happens that condi- 
tions present themselves which w r e must be 
careful not to overlook. Thus, independently of 
any special symptoms, a child during the second 
dentition, and especially during the eruption of 
the molars, may appear wanting in its usual 
spirits, sometimes suffering, though not severely, 
with headache and lassitude, and the appetite 
is not unfrequently either diminished or 
capricious. Such symptoms are most commonly 
met with when the second molars are being 
erupted, and they are, though no doubt much 
influenced by, often attributed wholly to, the 
period of puberty having arrived. With a 
history of or tendency to epilepsy the period of 
the second dentition is one of importance and 
anxiety, especially during that of the eruption 
of the third molars, and a considerable increase 
in the number and frequency of the fits often 
occurs, followed generally by an improvement 
upon the complete eruption of the teeth. 



The local symptoms attending tlie second 
dentition are also generally less severe than 
with the first, but it is by no means uncommon 
to find the mouth so swollen that the gums of 
the upper and lower jaws over the erupting 
teeth come in contact before the remainder of 
the teeth meet rendering the complete closing 
of the jaws impossible, and any attempt at 
mastication futile and painful. Soothing appli- 
cations to the gum such as an infusion of 
poppyheads will usually result in the rapid 
subsidence of the swelling, or if the mouth 
is hot and painful and the gum white and 
tense, manifestly stretched over the crown of 
the tooth, the employment of the lancet will 
soon give relief. With the eruption of the 
third molars, or wisdom teeth, as they are 
called, considerable trouble is often experi- 
enced. Those in the lower jaw especially often 
appear so far back that only one cusp or point 
shows through the gam, the rest of the crown 
being buried in the folds of soft flesh that 
connect the upper and lower jaws at the back 
of the mouth. This flesh is not attached to the 
crown of the tooth, as can readily be ascer- 
tained by a probe, but forms a sac or bag enclos- 
ing it. This sac is not self cleansing, and is 
liable to become offensive, owing to the imprison- 
in ent of the secretions, or from other causes 


giving rise to swelling and severe inflammatory 
symptoms which, spreading to the muscles, 
either impede or totally prevent the movement 
of the jaw (trismus). A complete removal of 
the membrane covering the top of the tooth 
either by the lancet or gam scissors, after- 
wards fomenting the part with hot infusion of 
poppyheads, to which a small quantity of 
chlorate of potash has been added, is the treat- 
ment usually successful. A recurrence of the 
trouble may take place, as the gum sometimes 
slowly creeps back and again partly covers the 
crown, and the extraction either of the second 
molar, if decayed, or of the imperfectly erupted 
wisdom tooth will prove the only effectual 

Irregularity of the Teeth. 

Irregularity is more common with the second 
than with the first set, and it is always more 
important, as the defect lasts through life. 

The symmetrical appearance of the teeth and 
their utility for mastication depend to a great 
extent on their occupying their regular places 
in the dental arches. In the normal mouth 
the points or cusps of the back teeth in the 
lower jaw fit into the depressions of those 
in the upper jaw, thus presenting the greatest 


possible surface for mastication. Irregularity 
of position by interfering with this perfect 
occlusion greatly reduces the masticating effi- 
cacy of the teeth, while the impossibility of 
cleaning the spaces between crowded and 
irregular teeth is favourable to their early 
destruction by decay. Pronunciation is often 
rendered indistinct and the lips, gums, and 
tongue irritated by teeth projecting inside or 
outside the dental arch. The deviation from 
the normal position may vary both in form and 
extent. Simply one tooth may be slightly dis- 
placed, or the whole set may be in such an 
indescribable state of confusion that scarcely a 
single tooth seems to occupy the place properly 
assigned to it, seriously interfering with the 
symmetry of the face and the mastication of the 

Irregularity may arise from a variety^ of 
causes — from the too early removal or from the 
undue retention of the temporary teeth : from 
a disparity in size between the jaws and the 
teeth, large teeth being erupted in a small jaw 
or, vice versa, through injuries to the jaw 
during the development of the teeth : from the 
presence of extra or supernumerary teeth : from 
a persistent indulgence in such habits as suck- 
ing the tongue, fingers, or thumb during child- 
hood. The habitually open mouth, continually 


associated with enlarged tonsils and mouth 
breathing, also tends to produce a contracted 
and ill-developed V-shaped dental arch fur- 
nished with crowded and irregular teeth. 

Fin. 15. — An irregularity caused by thumb sucking. 

The V-shaped, . contracted dental arch is 
quite amenable to treatment and is generally 
expanded by the use of a plate fitting the 
palate with or without covering the teeth. 
The plate is sawn in half and a spring is 
introduced, in such a manner that it has a 
constant tendency to force the two halves 

Disproportion in size of the upper and 
lower jaws is of frequent occurrence. The 
upper teeth are often very short and much too 
far outside the lower ones so that the front 
teeth actually rest on the lower lip, completely 
hiding the lower teeth, when the jaws are 
closed. Frequently the cutting edges of the 



upper teeth shut squarely on those of the 
lower, causing both to wear away. 

Fig. 1G. — Upper jaw with contracted Y-shaped dental arch. 

In other instances the lower jaw protrudes 
and the teeth are thrown far in advance of the 

Fig. 17. — Split plate with spring (a) for expanding dental arch, 



upper ones, giving a " bull-dog " appearance 
that is anything but agreeable. Occasionally 
the back teeth alone antagonize, while there 
remains a considerable space between the front 
teeth which cannot be closed by any effort. 

Fro. 18. — Split plate for expanding the dental arch in position 
in the month. 

The incisors, canines, and bicuspids are 
frequently seen to have a portion of their 
number crowded outside the arch, while 
others are pushed inside, some of the teeth 
of the opposite jaw shutting among them in 
such a way as to lock them in their irregular 

The same teeth are often turned partially 
around, lapping over one another, or having 
their sides presented where the fronts ought 


to be. In some cases the teetli change places, 
the canine exchanging position with the 
lateral, or the lateral with the central, etc. 
The failure of certain teeth to erupt, after the 
loss of the temporary ones, allows their un- 
filled spaces to be encroached upon by the 

Fro. 19. — Same mouth after treatment with spring'expanding 

plate showing a great improvement in conformation of jjthe dental 

neighbouring teeth, causing a straggling ap- 

The same condition often occurs from the 
loss of teeth by decay or accident where there 
is no artificial substitute. Teeth sometimes 
erupt in the roof of the mouth and deformed 
and supernumerary teeth appear in different 
parts of the arch. 

Figs. 20 to 22 illustrate the evil results of 



the too early removal of the temporary canine 

Fig. 20. — Month of a child eight years old. The four front 
permanent teeth are compelled to assume an irregular position 
owing to the small size of the jaw. 

Fig. 20 shows the mouth of a child about 
eight years of age. It frequently happens, 
as in this case, that the four permanent front 

Fig. 21. — Same mouth as fig. 20 at eleven years of age. The 
temporary canines c c fig. 20 having been improperly extract! d 
to give 100m to the four front teeth. The teeth have thus been 
allowed to occupy the space required for the permanent canines 
(fig. 21, c c). 



teeth appear in the space previously occupied 
by the same number of small temporary teeth, 
and consequently are forced to assume a more 

Fig. 22. 

Fig. 23. 
Figs. 22 and 23 show the same mouth as fig. 20 at the age of 
fourteen. The too early extraction of the temporary canines has 
prevented the normal growth of the jaw, and thus no room 
remains for the permanent canines which are erupted outside 
the arch. 

or less irregular position. Now obviously the 
easiest way to give room for the newly erupted 
permanent teeth to arrange themselves regularly 
is to extract the temporary caniues (fig. 20, oc). 
The immediate result of such treatment is very 



satisfactory and by the eleventh year the teeth 
have assumed the position shown in fig. 21. 
About the completion of the twelfth year the 
permanent canines are erupted. As there 
is no space remaining for them they are 
forced outside the arch as shown in figs. 22, 
23, and produce an unsightly irregularity and 
one extremely difficult to treat successfully. 

Fig. 24. — Shows probable condition of same mouth as fig. 20 at 
the age of eleven, no teeth having been extracted, the four front 
irregular teeth having assumed a regular position through the 
room afforded by the natural growth of the jaw. c c are the 
temporary canines, the rest of the teeth belong to the permanent 

Returning to fig. 20, if the temporary canines 
(c c) had been allowed to remain, the natural 
growth of the jaw would have allowed the 
irregular front permanent teeth to assume the 
normal position without the extraction of the 



temporary canines (fig. 20, c c) in the course of 
a year or so, and by the end of the eleventh 
year the teeth would have been equally 

Fig. 25. — Same mouth as fig. 24 at the age of thirteen. The 
temporary canines have been shed leaving ample room for their 
permanent successors which are just appearing through the 

Fni. 20. — Showing the same case after thp permanent canines 
have been erupted, all the teeth being regular. 



regular, and a better development of the jaw 
would have resulted from the retention of the 
temporary canines (fig. 24, c c), while those 
teeth would have preserved the place for the 
reception of the permanent canines when the 
time for their appearance was reached as 
shown by fig. 25. 


Fig. 27. — A case of irregularity. 

Fig. 28. — The same mouth after treatment. 

Judicious extraction to give room, filing, 
plates, ligatures, screws, caps, inclined planes, 
etc., are the means generally employed to 


correct irregularities ; but it will be impossible 
to lay down any directions which will be appli- 
cable to all cases, as there are hardly any two 
precisely alike. It may be received as a general 
truth, however, that any case of irregularity 
of the teeth can be either completely corrected, 
or very materially improved by use of the 

Fig. 29. — Upper regulating plate in mouth, plate covering back 


proper means. The patient should be neither 
too young nor too old. If too young the subse- 
quent changes of the growing jaws may operate 
against permanent benefit ; and a lack of the 
appreciation of the good results would prevent 
the diligence demanded from the patient in 
wearing the appliances, keeping them cleaned, 
etc. If too old the teeth are so firmly set that 
it requires a much greater amount of time in 
which to accomplish a certain result. 



For anything like a complicated case, from 
twelve to fifteen years of age is the best time. 
Slight irregularities, such as two teeth pre- 
senting anteriorly or posteriorly, may be 
treated much earlier. 

Fig. 29 represents a type of case where very 
early treatment is imperative ; it illustrates an 

Fig. 30. 

upper jaw in which the two central incisors 
have erupted in the palate, with their cutting 
edges inside the lower teeth. As the lower 
teeth bite outside them when the mouth is 
closed they cannot possibly move forward 
without the aid of a mechanical appliance. 
The regulating plate is shown in situ. It is 
necessary to cover the back teeth in order 
to allow the upper front teeth to pass in free 
of the lowers. Mastication is carried on by 



the lower back teeth biting on the regulating 
plate. The irregular incisors are forced forward 
by small pegs of compressed hickory, which 
swelling by the absorption of the moisture 
in the mouth, gradually force the irregular 
teeth forward. These pegs have frequently 
to be renewed. 

Fig. 30 represents a lower jaw with a wire 
spring regulating appliance in its place, de- 

Fig. 31. 

signed to retract a canine tooth which has 
come through the gum too far forward. 

The regulation of teeth frequently requires 
great patience both on the part of the patient 
and the operator. The appliance has to be 
worn for many months, and frequent alterations 
of the springs, wires and ligatures are neces- 
sary. Trouble sometimes arises owing to the 


visits to the dentist interfering with the school 
attendance, and the treatment of a case is often 
rendered protracted and unsatisfactory by the 
dentist having to regulate his appointments by 
the holidays of his patient rather than by the 
exigencies of the case. 

After the teeth have been directed into the 
required position, it is often still necessary to 
wear the plate for some months until the 
teeth become consolidated into their new 

Fig. 32. 

Much can be done in even the most hopeless 
looking cases of irregularity of the teeth. Figs. 
ol and 32 are drawn from the models of an 
extremely complicated case of dental irregu- 
larity which came under the care of a well- 
known practitioner. 




Fig. 34. 

Figs. 33 and 34 show the same mouth after 
treatment extending over a period of two 

The successful result here shown could only 


be obtained where the dentist's efforts are 
seconded by a thorough co-operation on the 
part of the patient. 

The Structure of the Teeth. 

The structure and composition of the teeth 
present many points of interest, and help to 
enlighten us in acquiring a knowledge necessary 
to promote their welfare. The portion of the 
tooth visible as it occupies its natural position 
in the mouth is known as the crown ; that 
portion concealed by the gum is known as the 
root, while the line at which the gum first 
comes in contact with the tooth is called the 
neck. The roots of the teeth are fixed in 
sockets of thin bone, which are formed simul- 
taneously with them, and are known as alveoli, 
and by which they are firmly embraced. The 
bulk of the tooth is built up of an ivory-like 
substance known as dentine. The crown is 
covered and protected by a thin layer of 
enamel, which is a tissue of extraordinary 
hardness. The root is covered with a similar 
layer of different structure known as cementum. 
In the centre of the tooth is a cavity containing 
the pulp, or as it is popularly known, as the 
nerve of the tooth. This pulp is a wormlike 
fleshy structure containing a nerve, vein and 



artery, and assists in the formation and 
nutrition of tlie tooth. The position of these 
tissues can be seen from the accompanying 

illustration (fig. 35), which 
represents a molar split 
vertically and transversely 
to show the relative posi- 
tions occupied by the 
various tissues composing 

The enamel is the cap 
or covering of the crown : 
it is the hardest tissue of 
the body. It is thickest 
on the cutting edges and 
masticating surfaces, gra- 
dually becoming thinner 
towards the neck, at which 
point it is met or slightly 
overlapped by the ce- 
mentum. The enamel is 
possessed of very slight, 
if of any, sensibility. It 
contains not more than 
four per cent of animal 
matter, and is almost 
entirely soluble in acids. Under the micro- 
scope it is found to consist of rows of hexagonal 
parallel fibres lying side by side. 


a, Longitudinal Section 
of a Molar. 

i?, Transverse Section. 

(c) The cementum. 

(d) The dentine. 

(e) The enamel. 

(n) The pulp or nerve of 
the tooth. 


The cement um is a layer of hard tissue 
covering the roots of the teeth. It is inter- 
mediate in hardness between dentine and bone, 
resembling the latter more than either of the 
other hard tissues found in a tooth. It is 
thickest at the end of the root, gradually 
diminishing until it seems to unite with or 
slightly overlap the enamel at the neck of the 
tooth. The dentine or so-called ivory con- 
stitutes the bulk of the tooth. It is, so to 
speak, its framework, giving each tooth its 
size and shape. If the enamel and cementum 
were removed the dentine would still preserve 
the general form of the tooth. It contains over 
one-fourth of animal matter, and when sub- 
jected to the action of acids the earthy matter 
is dissolved out, leaving a cartilage -like mass 
retaining the form of the tooth. Examined 
microscopically it is found to consist of in- 
numerable tubes of a diameter of about -45W 
of an inch. It is usually highly sensitive both 
to variations of temperature and to contact 
with foreign substances. It owes its sensitive- 
ness to the pulp of the tooth, and when the 
pulp dies the dentine loses its sensibility. 


Decay of the Teeth. 

Caries, or dental decay, is one of the most 
prevalent diseases of modern life, and it evinces 
so strong a tendency to increase that it is rare 
to find an individual among the civilized por- 
tions of the human race whose mouth does not 
show some evidence of its ravages, or who has 
never experienced the pain that accompanies it. 

The causes of decay are predisposing and 
exciting. The predisposing causes are imper- 
fect structure, irregularity of position, and 
mechanical injuries. Conditions inherent in 
the teeth by virtue of their original structure 
determined before birth or during infancy, 
establish in many cases a predisposition to 

Owing either to imperfect health of the 
mother during the development of the teeth, 
or to disturbances of the health of the child 
during their formative stage, the various pro- 
cesses of organization are liable to be so inter- 
rupted and deranged as to result in defective 
dental structures. The dentine is soft and 
friable, the enamel semi-crystallized and 
deficient in quantity and quality — a hetero- 
genous mixture of animal and earthy materials. 
Teeth thus imperfect in their texture are 



necessarily not fitted to resist the action of 
destructive agents. 

The same may be said of those with deep 
fissures, reaching through the enamel to the 
dentine, whose edges are imperfectly joined. 

Fig. 3G. — a. Upper Canine 
Tooth with badly formed 

Fig. 36. — b. Section of a 
Molar showing a fault or fis- 
sure in the enamel (a) caused 
by imperfect development. 
These fissures are frequently 
the starting point of decay. 

Neglect of the temporary teeth is a pregnant 
cause of the decay of the permanent set. The 
process of shedding the temporary teeth ex- 
tends over a period of six years. Under normal 
conditions the appearance of its permanent 
successor is simultaneous with the falling out 
of the temporary tooth, and owing to the order 
in which the temporary teeth are shed temporary 
and permanent teeth stand side by side' in the 
same mouth, in certain positions, for several 

The permanent lateral incisor is erupted 
during the eighth year : the temporary canine 
is not lost until the thirteenth year, and thus 


Fig. 37. 

Fig. 37 shows the Upper Jaw of a child five years of age, the 
temporary lateral incisors (n b), the canines (c c), and the posterior 
molars (e e) are decayed. 

these teetli remain in close contiguity to each 
other for a period of four years. The first 

;Fig. 38. 

Fig. 38 shows the same mouth during the eighth year; the 
permanent centrals (1 1) have appeared and the laterals (2 2) 
are being erupted in close contact with the temporary canines 
(c c). The two permanent molars (6 6) have been in position 
some time and have become carious through contact with the 
second temporary molars (e e). 



permanent molar makes its appearance during 
the sixth year, and from that time until the 
twelfth year remains in contact with the second 
temporary molar. 

Fig. 3D. 

Fig. 39 represents the same mouth at the age of nineteen. The 
left lateral (2), originally rendered carious by contact with de- 
cayed temjjorary canine (fig. 38, c), has broken off and rendered the 
permanent canine (i$) and central (1) carious, while on the right 
side the decay originating in the temporary canine (figs. 37 and 
38, c c) has effected the permanent lateral (2), and through that 
tooth the permanent canine (3). The first permanent molar each 
side has decayed away to a mere stump, causing the second 
permanent molar (7 7) and the posterior bicuspid (5 5) to decay. 
Thus, at the age of nineteen, eleven teeth of the permanent set 
are rendered useless, as the direct result of the neglect of the 
decayed temporary canines and molars in the mouth at the age 
of five years. 

Now if the temporary canine happens to be 
decayed the caries rapidly spreads to the 
permanent lateral incisor, while the decayed 
temporary molar communicates the disease to 
the first permanent molar. The germs of decay 


are thus conducted from the first to the second 
set of teeth, and the decay spreads from one to 
another until every tooth in the mouth is in a 
ruinous and useless condition, possibly before 
the sufferer is out of his teens. 

Figs. 37-39 are intended to illustrate the 
disastrous effect of decayed temporary teeth on 
the permanent set. The temporary teeth are 
distinguished in the cuts by the letters a, b, c, 
d, E ; the permanent teeth by the numbers 
1, 2, 3, 4, 5, 6, 7, 8. 

Mr. Chas. S. Tomes points out that: "In a 
perfectly normal, well -formed jaw the teeth 
are individually so shaped, and are so arranged 
that they touch one another by curved surfaces 
only, so that the areas of contact are very 

" As teeth are not rigidly fixed, but are capable 
of a small degree of motion, they rub against 
their neighbours, and in time wear the curved 
surfaces of contact into small flat facets, but 
still the areas of contact remain small, and are 
well removed from the gum. 

" But in a crowded mouth this is all altered ; 
the teeth standing irregularly come into contact 
with their neighbours by other than the proper 
surfaces, and oftentimes they touch over a far 
larger area, extending right down to the gums. 
And when the oft - repeated slight motions 


of the tooth begin to take effect, enamel is 
crushed or worn away over irregular areas 
which, damaged thus, as well as by being lurk- 
ing places for fermentation to go on in, become 
the starting points of decay." 

Fir;. 40. — The second Bicuspid and first and second Molar 
teeth, showing the surfaces in contact (.#•) are very small: //. 
edsre of °;u.m. 


Irregularity of position, from whatever cause, 
renders the teeth liable to decay. 

When they lap over one another or touch at 
points other than those which are intended to 
come in contact in a natural and orderly 
arrangement, decay at such points is apt to 

The difficulty of keeping irregular teeth clean 
is another fruitful cause of decay, the retention 
of food being favoured by their positions. 
Mechanical injuries — falls, blows, and improper 
use of the teeth, destroying the continuity of 
the enamel — also predispose to decay. 

The exciting causes of decay are chiefly 
different forms of chemical action, which may 
either follow from the use of acids as food or 


medicine, or be caused by improper tooth- 
powders or washes ; or may result from a vitia- 
tion of the secretions of the mouth, either from 
a general systematic derangement, or from a 
local cause, such as mumps, sore throat, or the 
presence of tartar about the necks of the teeth, 
causing an irritation of the sfums and inducing 
an acid secretion ; or from the fermentation 
and decomposition of food about and between 
the teeth. 

Decay never begins on the smooth sur- 
faces of teeth — those which are exposed to 
the friction of mastication — but always com- 
mences at points which, owing to their structure 
and arrangement, furnish convenient recep- 
tacles for decay-producing agents. The points 
most favourable to such retention are the deep 
fissures of the bicuspids and molars (fig. 36b), and 
the sides of the teeth where they come in contact 
with each other. In these crevices and at the 
surfaces which the teeth present to each other, 
and which favour the lodgment and retention of 
food and mucus, decay is most likely to begin 
and, once begun, to continue. It proceeds 
slowly, perhaps, so far as the enamel is con- 
cerned, but when it reaches the dentine, either 
through a fissure in the enamel, or a breach 
made through its walls, it progresses more 
rapidly until the pulp is reached, and its vitality 


and the strength and substance of the tooth 
are destroyed. 

Whatever may be said of the deleterious 
effects of tobacco upon the general system, 
it has not been proved to have any influence 
in the production of caries, although the 
discoloration which results from its continued 
use detracts markedly from the appearance of 
the teeth. 

Sugar and confections exercise no directly 
injurious effects upon the teeth, but when taken 
in excess produce an acid condition of the 
stomach, unfavourable to the health of the 
mouth, and when left in the interstices of the 
teeth rapidly undergo an acid fermentation, 
resulting in a product capable of acting very 
injuriously upon tooth structure. 

The process of decay of the teeth is as varied 
in different individuals and at different times as 
is the character of the disintegration. It 
proceeds sometimes insidiously and slowly, 
and again with wonderful rapidity, sometimes 
announcing its ravages by a sensitiveness of 
the exposed dentine to sweets and acids and to 
changes of temperature, and at other times 
giving no notice of its presence until an 
exposure of the pulp has been made, when the 
pangs of toothache are experienced. 


Toothache and Neuralgia. 

When from exposure by decay or other 
causes the pulp becomes irritated and inflamed, 
the pain known as toothache arises ; but dur- 
ing the progress of decay, even before the 
exposure of the pulp has been effected, pain of 
more or less severity may be experienced, fre- 
quently diffused over the sides and top of the 
head, and not apparently referable to the 
teeth at all. 

These pains are generally ascribed to 
neuralgia even by medical practitioners, and 
quinine and other tonics are prescribed and 
taken in considerable quantities, without effect. 
After a course of medical attendance the patient 
is referred to the dentist and a careful examina- 
tion of the mouth frequently reveals several 
unsuspected cavities, the treatment of which 
gives immediate relief from suffering. 

When consulted in cases of neuralgic pains 
about the head and neck it is advisable in most 
cases for the medical man to refer his patient to 
the dentist for a thorough examination of the 
mouth as a preliminary to treatment, and not 
to delay doing so until the failure of medicine 
to alleviate the pain points conclusively to the 
fact that the trouble is of dental origin. 

It is true that the physician looks at the 


teetli before prescribing, but many teeth that 
appear sound on a mere inspection of the 
mouth prove to be badly decayed when 
thoroughly examined by a dental surgeon, who, 
by aid of his special appliances and knowledge, 
is better able to diagnose defects in the teeth 
than the general medical practitioner. 

Dr. W. H. Williamson, in his presidential 
address to the Aberdeen Medico-Chirurgical 
Society on the relation of Dentistry to Medical 
Education, remarking on the subject, says : — 

" Take, for example, the simple, but yet very 
important point of the examination of the 
teeth, not unf requently attempted by doctors for 
tlie purpose of ascertaining the cause of facial 
neuralgia, which in ninety-nine cases out of 
a hundred is of dental origin. A general 
glance of the opened mouth is taken, and if there 
is no blackness or distinct hole to be seen the 
verdict is that, as the teeth seem sound, there- 
fore they may be excluded from the list of 
causes. This superficial idea of what consti- 
tutes an examination leads to many errors of 

"Very early in practice I remember a case of 
a lady who had been under the care of a very 
deservedly celebrated London consultant, who 
is cited in one of our dental books as having 
been remarkably acute in diagnosing obscure 


cases of dental disease. The patient was 
suffering from neuralgia, and her mouth was in 
due course examined, but as no cause was dis- 
covered there she was put on a course of some 
anti-neuralgic, which did her no good. It 
would seem just at first sight, when she opened 
her mouth, that it was a very simple matter to 
tell whether her teeth were the source of 
trouble or not, for on the affected side — on the 
lower jaw at any rate — there was but one 
solitary molar coming well forward which had 
quite a good, sound-looking appearance, but on 
pressing the cheek away with the finger a large 
cavity was disclosed on the outside, with an 
exposed pulp at the bottom of it. The destruc- 
tion of the pulp cured in a couple of hours a 
painful affection of some two months' stand* 

" Another instance occurred to me a few 
months ago of a girl of about twenty, who came 
to me suffering from neuralgia. On inspection it 
was at once evident that her teeth were in a 
very bad condition, there being hardly a sound 
tooth behind the canines, above or below, in all 
stages of disease, some with pulp exposed, most 
with dead pulp, and some of the roots almost 
entirely covered by fungous growths of gum — 
an evidence, to a dentist, of long-standing 
disease ; and yet this condition had not been 



recognized by the medical man consulted, who 
bears an excellent reputation, and is of the 
modern school." 

Fig. 41. — Diagram of Trifacial Nerves. 

1, Ophthalmic branch. 

2, Superior maxillary branch (upper jaw). 

3, Inferior maxillary branch (lower jaw). 

Neuralgic pains of dental origin are due to 
reflected or sympathetic action. It will be seen 



by referring to the diagram of the nervous con- 
nections of the teeth that they consist of three 
main branches which ramify to almost every 
part of the face, mouth and head, and irritation 
to one branch often gives rise to pain at a 
portion of the nerve very remote from the 
source of injury. Thus the irritation caused 
by a decayed tooth in the lower jaw may be 
reflected in such a manner that the pain is 
experienced in the upper jaw, and vice versa. 

Toothache arising from the 

Inflammation of the Nerve of the 

Tooth (Pulpitis). 

The occurrence of pain in a tooth is gener- 
ally evidence of the exposure and consequent 
inflammation of the nerve. It is then necessary 
to kill the nerve (or pulp) and afterwards 
remove it and to fill the pulp cavity with an 
antiseptic stopping, and finally to stop the 
cavity caused by decay. When the nerve has 
been thus killed the tooth is what is technically 
known as " dead," and although a tooth in 
this condition may remain useful for years 
there is a liability for it to become loose, 
tender, and ultimately abscessed, necessitating 
its removal. 

In the past terrible sufferings were inflicted 



on unhappy patients in attempts to destroy the 
nerve of a tooth by hot needles, etc. But 
the operation, as now performed, is quite 
painless. The decayed dentine is cleared 
away as far as possible, a small portion of 
specially prepared paste placed in contact with 
the exposed nerve and a temporary stopping 
inserted in the tooth. This is allowed to 
remain from twenty-four to forty-eight hours. 

Fig. 42. — Sections of decayed teeth showing (a) tooth in which 
the decay has not reached the pnlp cavity (or nerve), and which 
can be therefore stopped without destroying the pnlp. b Tooth 
in which the decay has reached the pnlp cavity (or nerve), and 
destruction of the pulp is necessary. 

On taking out this stopping the nerve is found 
quite dead and has then to be removed from 
the tooth and the pulp cavity filled and the 
tooth stopped. 

Considerable misapprehension exists in the 


public mind with regard to " killing the nerve," 
and it is not unusual for a patient with an 
aching tooth and swollen face to request the 
dentist to "kill the nerve" of the tooth, perfectly 
oblivious to the fact that the trouble is really 
an abscess set up by the dead and decomposed 
nerve. When the sufferer is informed that 
the nerve is already dead he looks incredulous 
and assures the dentist that he (the dentist) 
is mistaken. " The tooth aches. How can 
a tooth ache if the nerve is dead ? ,: The 
pain in a dead tooth arises from inflammation 
of the membrane lining the socket of the tooth 
and is distinguished from pulpitis (i.e. tooth- 
ache arising from inflammation of the nerve) 
by the tooth feeling longer than usual and 
preventing the patient closing the mouth with 
comfort, and is frequently accompanied by 
swelling. With pulpitis no swelling occurs, 
and the teeth coming into contact on closing 
the mouth cause no uneasiness. 

Killing the nerve or pulp is only a pre- 
liminary to filling the tooth, and unless followed 
up by stopping would in the majority of cases 
be injurious rather than beneficial in its results 
and lead to the production of an abscess at 
the root of the tooth. 

For the relief of toothache arising from ex- 
posure of the pulp (pulpitis), a little ball of 


cotton wool saturated with oil of cloves or car- 
bolized collodion perhaps is the best amateur 
treatment. Care must be taken not to smear 
either of these agents over the lips or face, as 
they will cause painful blisters. When once a 
tooth has ached a recurrence of the trouble is 
likely, and permanent relief can only be ob- 
tained by consulting a dentist and having the 
tooth properly stopped or, if necessary, ex- 

Periodontitis and Alveolar Abscess 

Although the complete or proximate exposure of 
the pulp and its consequent inflammation (pulp- 
itis) is one of the most frequent causes of 
toothache, this pain may arise from other 
sources. The sockets of the teeth are lined by 
a delicate membrane, attached both to alveoli 
or sockets and to the cementum of the tooth. 
This membrane may become inflamed and 
thickened, lifting the tooth slightly in its 
socket, and making it feel long and tender, 
rendering mastication difficult ; until as the in- 
flammatory action increases, it becomes impos- 
sible to close the mouth without experiencing 
intense pain. This form of toothache known 
as periodontitis is often amenable to treatment, 
but if neglected generally culminates in gum- 


boil or alveolar abscess, and occasionally in the 
necrosis or death of a portion of the jaw bone. 

Periodontitis may arise from cold, mechanical 
injury, or the accumulation of tartar round the 
necks of the teeth, but the most severe cases 
are generally those associated with " dead 
teeth," that is, teeth in which the nerve has 
died through exposure by decay, broken 
down teeth and roots, which, after giving pain, 
have ceased to ache for some time. 

The nerve canals of such teeth are generally 
in an indescribably foul condition owing to the 
putrifaction of the dead pulp, and filled with 
highly septic matter, a particle of which, acci- 
dentally forced through the opening at the 
point of the root, by which the nerve originally 
entered the tooth is quite sufficient to set up 
violent inflammation in the socket of the tooth, 
often accompanied by severe constitutional 
symptoms, swelling of the face and neck, and 
abscess at the root of the tooth, the resulting pus 
generally finds its way to the surface of the gum 
opposite the abscess, or at some other point 
in the mouth, forming what is popularly known 
as "gum-boil." After the discharge of the pus 
the pain subsides and the swelling gradually 

But the disease is not cured, and after a 
longer or shorter period, depending on various 


circumstances — notably on the good or ill 
health of the individual — there will be a recur- 
rence of the abscess. If this is repeated too 
often the bony socket of the tooth becomes 
affected, the sockets of adjoining teeth partici- 
pate in the trouble, the teeth lose their vitality 
and drop out, and sometimes necrosis (death) 
of a portion of the jaw follows. Sometimes 
the pus instead of finding exit near the 
affected tooth, burrows among the tissues, and 
makes an outlet for itself at a distant point 
inside or outside of the mouth, not infrequently 
producing disfiguring scars on the face. When 
the symptoms indicate periodontitis treatment 
should be instituted with a view to prevent the 
formation of an abscess, or if this effort fails, 
to influence it to open at a desirable point — 
inside of the mouth and not upon the face. 

Domestic treatment is usually wrongly 
directed, and that prescribed by the average 
general practitioner is equally at fault. The 
best possible advice that can be given is to 
consult a dental surgeon at an early stage of 
the trouble, at which time it can frequently 
be averted. 

The treatment of alveolar abscess is within 
the province of the dental surgeon, and his 
experience and facilities for the antiseptic 
treatment of teeth and other necessary opera- 



tions in the reduction of alveolar abscess are 
greater than those of the family medical man. 
If unable to consult a dentist immediately, an 
excellent palliative treatment is fomenting the 

Fig. 44. 

Fig. 43 shows a section of the lower jaw with a tootli having 
an abscess under it which, by treatment such as hot fomenta- 
tions used inside the mouth, has been led to discharge into the 
space existing between the cheek and the gum, causing no dis- 

Fig. 44 represents what would probably occur if the same 
abscess were treated by poulticing the outside of the face. The 
pus being drawn towards the poultice would discharge through 
the cheek forming an ugly and permanent scar. 

inside of the mouth with hot water or with an 
infusion of poppy heads (made by boiling 2 ozs. 
of poppy heads for ten minutes in a pint of 
water) held in the mouth, or a toasted fig held 
against the gum will frequently give great 
relief and hasten the forming of the abscess. A 
poultice should never be used on the outside of the 



fase, and if the extraction is necessary, it is not 
advisable to wait until the swelling subsides, but 

Fig. 45. 

Fig. 45 explains the treatment of alveolar abscess teeth by 
the extraction of the tooth causing it. The abscess sac is broken 
by the extraction and the pus can be removed by syringing well 
with a weak solntion of carbolic acid or Lister ine. 

to have the tooth out at the earliest possible 
moment. The extraction is almost invariably 
followed by a complete evacuation of the 
abscess and a subsidence of inflammatory 

As the alveolar abscess forms it dissolves or 
absorbs a portion of the bone of the jaw, thus 
forming a cavity at the bottom of the socket 
which is occupied by the abscess sac, a mem- 
braneous bag containing pus. Figs. 43 to 45 
are intended to illustrate the effect of the 
different modes of treating an alveolar abscess. 


The following typical case of a disfiguring 
external wound on the face, caused by im- 
proper treatment of an alveolar abscess, is 
given by the dental surgeon to the Evelina 
Hospital for Sick Children — 

"A. F., a girl aged five years, of pallid com- 
plexion, complains of a sore on her face. Had 
toothache some months ago ; three weeks since 
the face suddenly swelled up, causing much 
pain. It was well poulticed by the mother. 
The child had an unhealthy-looking sore on 
the left cheek opposite the molar region of 
the lower jaw. It was small in size, circum- 
scribed, and on its summit there was a small 
papilla from which pus was oozing. Careful 
probing showed a direct connexion with the 
roots of a lower temporary molar which was 
found deeply carious, but firm in its socket. 
This was removed and in one week the scar 
alone remained." 

This gentleman, commenting on this case, 
writes : " As in this instance advice is often 
sought when the mischief is done." It also 
illustrates a method of treatment frequently 
adopted by the ignorant, viz., that of poultic- 
ing swellings upon the face which, if nothing 
else happens, may leave a life-long scar. 

Dr. W. H. Williamson, in his presidential 
address to the Aberdeen Medico-Chirur^ical 



Society, January, 1901, on " The Eelation of 
Dentistry to Medical Education," says : 

" When an alveolar abscess is developing it 
is by no means an uncommon error for a doctor 

Fin. 46. — Showing wound on the cheek caused by poulticing 
an alveolar abscess (gum-boil). 

to advise outside poulticing, the consequence 
being external fistula, leaving more or less of 
a scar on the face, according to the length of 
time it has been allowed to remain untreated ; 
that is to say, the offending tooth or root 
not having been removed. When this how- 
ever is done, it is astonishing with what 
rapidity the sinus heals up without any further 
treatment whatever." 


In practice cases are often met with where 
medical men have directed poulticing the face 
for alveolar abscess and have afterwards lanced 
the abscess on the exterior of the cheek or 
under the chin, producing an unsightly scar. 
Under dental treatment an external wound 
from an abscessed tooth is practically unknown. 
Even when the pus is on the point of discharg- 
ing through the cheek the dentist strengthens 
the skin by painting with collodion, supports 
it with a bandage and opens and disperses the 
contents of the abscess either through the 
socket or by lancing the inside of the mouth, 
thus avoiding all risk of disfigurement. 

Stopping or Filling the Teeth. 

The process of removing the diseased portion 
of the tooth and replacing the loss by a substi- 
tute is known as stopping or filling — this is one 
of the most useful operations in dentistry, and 
when resorted to in time will almost invariably 
preserve a tooth and render it useful for a con- 
siderable period. Many, through a most unac- 
countable prejudice, will allow their teeth to 
decay one by one, enduring all the pain and 
misery attending a diseased and neglected 
mouth, rather than submit to the operation of 


filling, although in by far the greater proportion 
of cases it is perfectly painless, especially when 
professional aid is resorted to in an early stage 
of the disease, and when the best result can be 

The true advantages of filling are unknown 
to those who only consult the dentist when 
driven to do so by pain. An aching tooth can, 
after treatment, be successfully stopped, but the 
probability of success is far less than in cases 
where the stopping is completed before the ex- 
posure of the nerve, when the tooth needs no 
preliminary treatment except the removal of the 
decayed and softened tissue. 

The materials used for stopping are numerous, 
and range from gold to gutta percha. Grold is 
certainly the best and most durable stopping in 
suitable teeth, but in frail and rapidly decaying 
soft teeth it frequently proves very unsatisfac- 
tory, while with nervous and timid patients the 
strain of having a large gold filling inserted and 
consolidated is more than they can readily 

In these cases plastic fillings are employed. 
Plastic fillings consist of (a) Amalgams, (b) 
Osteo or cement fillings, (c) Gutta percha. 
Amalgams consist of a combination of gold, 
platinum, tin, silver and other metals, with a 
small proportion of quicksilver, and are intro- 


duced into the cavity in a pasty condition, where 
they rapidly harden. A good amalgam is as 
durable as gold, and resists equally well the 
attrition of mastication. It is of course far 
less costly. The great drawback of amalgam 
is that one that will retain its colour in all 
mouths has yet to be discovered, and even a 
slight discolouration is objectionable in front 
teeth. For front teeth the so-called osteo 
plastic stoppings are employed to a large ex- 
tent, and consist of a powder and liquid which, 
combined, make a white paste which sets hard 
in a few minutes and retains its colour in the 
mouth. These stoppings are sufficiently hard 
to resist the wear of mastication, but the saliva 
has a slightly solvent action upon them and they 
require renewing every two or three years. 
Gutta percha stoppings are chiefly used for 
temporary stopping, etc., but is fairly durable 
in some cases, as in small cavities near the gum 
margin, etc. 

Griitta percha, as used in dentistry, is prepared 
by the addition of a hydraulic cement which causes 
it to set hard in the mouth and is quite distinct 
from the so-called white enamel sold at the 
drug stores. This " white enamel," which is 
only ordinary white gutta percha, becomes in- 
describably offensive in the mouth and pollutes 
the breath terribly and, if introduced in a cavity 


batween the teeth, frequently by its expansive 
power forces the teeth apart, causing them to 
assume most unsightly positions, and possibly 
their loss by driving the gums back from the 

Fig. 47. — Showing two central teeth driven apart and the 
rest of the teeth disjriaced by amateur stopping with ordinary 
white gutta percha. 

What are known as mineral or porcelain 
inlays also make very artistic stoppings. The 
lost portion of the natural tooth is replaced by 
a small section of mineral tooth accurately 
fitted and cemented in the cavity. 

The mineral inlay is natural looking, and the 
least easily detected of all stoppings, and is 
especially suitable for small cavities in front 

Patients are of course not ordinarily quali- 
fied to judge of the relative merits of the various 
materials and methods, nor of their special 
applicability in individual cases, and cannot do 
otherwise than to select a qualified dentist, and 
submit to his judgment — very certain to be 
better than their own — and, having done so, to 
give him all the help in their power to secure 

9 6 


the good results desired by both. Good opera- 
tions of any and all classes fail often because of 
a want of cleanliness on the part of the patient. 
If the teeth decay because of unhealthy 
conditions of the mouth, produced either by 
constitutional or other causes, a continuance of 

1 2 4 3 

Fig. 48. — Porcelain Inla3^s. 

1, Central tootli with small decayed cavity in the front (a). 

2, Central tooth with cavity (b) prepared to receive porcelain 


3, Central tooth with porcelain inlay (e) in position. 

4, Prepared porcelain inlav, front of (c) ; transverse section 

Of (D). 

the same influences will produce further 
decay after the most thorough and most con- 
servative local treatment. A tooth that has 
been filled or filed is not, therefore, to be 
supposed invulnerable to the attacks of destruc- 
tive agents, and the dentist should not be held 
responsible for the patient's neglect. As a sick 
man requires more care than a healthy one, so 
a damaged tooth, even though repaired, needs 
more attention than a sound one. 


Tartar or Salivary Calculus. 

Tartar consists of the earthy salts of the 
saliva which are deposited about the sides and 
the necks of the teeth. It first forms a light, 
soft, creamy layer which hardens and thickens 
until, in extreme cases, the teeth are almost 
entirely enveloped in it. It generally presents 
a dirty, yellow, bone-like appearance, but may 

Fig. 49. — Showing a Mouth with accumulation of yellowish 
coloured Tartar collected about the necks of the teeth. 

assume a brown, green, or black colour. It 
varies from an almost flinty hardness to a soft, 
friable consistency. As a rule its hardness is 
in inverse proportion to its quantity; with small 
deposits which have been collecting for a con- 
siderable time the tartar is usually dark and 
hard, while with large and rapidly growing de- 
posits the tartar is light coloured and soft. 
The hard tartar adheres to the teeth with 



great tenacity, while tlie soft variety is easily 
removed. In fact it shows a tendency to break 
away spontaneously, leaving rough edges which 
excoriate the tongue and cheeks. 

In young people the permanent teeth soon 
after their appearance through the gum may 
become disfigured by the deposition of dark 

Fig. 50. — A case with considerable accumulation of rough 
dark yellow Tartar. 

green pigment upon the surface of the enamel. 
The habitual use of the tooth-brush and the act 
of mastication gradually rub off the pigment 
and the teeth are restored to their proper 
colour. If, however, the disfigurement remains 
after the teeth are fully developed and the 
enamel has acquired density, the unsightly ap- 
pearance may be removed by the dentist. 

It is frequently found that the enamel is 
roughened and chalky looking under this de- 
posit. If this is the case it may be smoothed 


and polished. This discolouration is possibly of 
vegetable origin, and is quite distinct from 

The deposition of tartar does little or no 
injury to the enamel of the tooth, and is cer- 
tainly not an exciting cause of decay in the 
teeth, but it is directly injurious to the gums, 
sockets, breath, secretions of the mouth, and to 
the general health. The first deposit irritates 
the gums; they inflame, perhaps suppurate, 
and recede ; here they would stop and heal if 
it were not for the continued addition of tartar, 

Fig. 51.— An Upper Molar Fig. 52.— Six Front Teeth 

lost through the accunrula- nearly covered with Tartar, 

tionof Tartar encroaching on and lost through its destruc- 

the sockets. ^ Ye effects on the alveoli 


which causes the gums to recede more and more. 
This deposition also encroaches upon the vessels 
affording vitality to the alveolar processes and 
the roots of the teeth; the devitalized processes 
are gradually absorbed, and finally, when they 
and the gums are both gone, the teeth become 
loose and fall out. So intolerably offensive does 
the breath become from some kinds of porous 


tartar which give lodgment to decomposing 
mucous and food, that it is almost insufferable. 

Fig. 53.— Molar Teeth with Fig. 54.— A collection of 

an accumulation of Tartar. Tartar gathered on the root 

of an Upper Bicuspid. 

The fluids of the mouth become vitiated, are 
taken into the stomach, which rebels at such a 
condiment ; the blood becomes full of impuri- 
ties, the system suffers, and often the best 
efforts of the physician fail while the cause 

An eminent writer, in his work on Dental 
Surgery, further enumerates the effects of 
tartar as follows : " Tumours and spongy 
excrescences of the gums of various kinds ; 
necrosis and exfoliation of the alveolar pro- 
cesses, and of portions of the maxillary bones ; 
hemorrhage of the gums ; loss of appetite ; de- 
rangement of the whole digestive apparatus ; 
foul breath; catarrh; cough; diarrhea; diseases 
of various kinds in the maxillary antra and nose ; 
pain in the ear ; headache ; melancholy, etc. 


Add to these closure of the salivary ducts, perio- 
dontitis, alveolar abscess, and various sympa- 
thetic pains : think a little — and then resolve to 
keep the teeth clean. There is one great means 
of cure, and that is the operation of scaling 
performed by the dentist." 

The removal of the tartar or scaling, as the 
operation is called, from the teeth is a painless 
operation, and if skilfully performed cannot 
possibly injure the teeth, and when we consider 
the benefits derived from having the teeth clean 
and the breath free from fetid taint, it is diffi- 
cult to see how any one paying any regard to 
their own welfare or the feelings of others can 
for one moment object to it. 


The advance of knowledge in dental surgery, 
the improvements in the treatment of decayed 
teeth, the use of antiseptics in the nerve canals, 
and recent improvements in crowning, render 
it possible to save many teeth that would other- 
wise be doomed to extraction. Almost any 
tooth can by persistent treatment be retained 
and rendered useful for a time unless it is 
absolutely loose ; but in the case of badly 
abscessed teeth the course of treatment re- 
quired is protracted, and unfortunately occupies 



more time than a busy patient can afford. 

While with nervous and delicate patients the 

strain of long operations is so exhausting 

that extraction becomes the 
only available remedy, espe- 
cially when the risk is con- 
sidered that after repeated 
antiseptic dressings, etc., 
spread over several weeks, 
there is still the possibility 
of failure to save the tooth 
and reduce the inflamed and 
abscessed socket to a rea- 
sonably healthy condition. 
When the extraction of a 
tooth is really necessary it 
is a folly to allow it to 
remain, causing pain and 
sleeplessness, pr eventing 
mastication and injuring the 
bodily health. The pain of 
extraction is not so great 
but what it can be faced by 
any ordinary individual with 
the exercise of a little cour- 
age, and even this pain can 

be avoided by the use of anesthetics. 

It is necessary that the forceps used should 

fit the teeth to be extracted, and as the teeth 

Fig. 55. — Forceps 
designed to extract 
stumps of upper molars 
when broken down to 
the level of the gum. 


differ greatly in shape a large number of in- 
struments is required to meet the exigencies of 
an ordinary practice, and not only is a special 
instrument necessary for each tooth, but addi- 
tional ones to extract teeth of varying size, or 
whose form or position deviate from the normal. 
Many consider the operation of extracting 
teeth to be one that requires little skill, and are 
willing to entrust their mouth for this purpose 
to the tender mercies of the chemist's assistant 
or any other individual who chooses to display 
the legend, "Teeth Extracted," in his window; 
but to become a really good operator in this 
respect it is necessary not only to have had 
considerable practice, but also to have a 
thorough anatomical knowledge of the teeth 
and jaws, and of such deviations from their 
normal condition as are likely to be met with 
in practice. 

Painless Extraction of the Teeth 
by Nitrous Oxide Gas. 

Nitrous oxide, or laughing gas, was the 
earliest discovered anesthetic, for as long ago 
as 1799 Sir Humphry Davy made use of the 
following words : " As nitrous oxide in its 
extensive use seems capable of destroying 
physical pain, it may probably be used with 
advantage in operations where no great effusion 


of blood takes place." This noteworthy ob- 
servation produced no result, and the grand 
idea that the peculiar properties of the gas 
might be employed for the good of suffering 
humanity lay fallow until the year 1844. In 
that year at a scientific lecture delivered in 
Connecticut, a local dentist noticed that a 
gentleman under the influence of nitrous oxide 
struck himself without experiencing any pain 
from the blow. Next day he visited the lec- 
turer in company with another dentist, and 
asked that he might be placed under the gas. 
Under its influence his fellow dentist pulled 
out one of his firmest teeth without his feeling 
it. Having experienced the result in his own 
person this man, whose name was Wells, 
speedily learned how to produce the gas, and 
applied it with every success in a number of 
dental cases. Unhappily he had not the 
necessary courage and hardihood to resist the 
opposition of the medical faculty. Offering to 
perform a public operation with the gas, he did 
so at a hospital in the presence of a large 
number of sceptical and sneering doctors. For 
some reason or other the patient cried out; 
Wells was unnerved, the doctors laughed him 
to scorn, and so great seems to have been his 
mortification that he died shortly afterwards. 
The lecturer however, Dr. Colton, would not 


abandon his faith in the " laughing gas ' so 
easily, after having once had his eyes opened 
by the unlucky Wells ; and for twenty years he 
continued to urge its use upon the dentists in 
America. For long years, possibly fearing the 
fate of Wells, they all refused to have anything 
to do with it. At last he was successful, and 
having won the day in the United States, Dr. 
Colton visited Paris with a clean record of 
20,000 cases without a single accident. The 
French faculty gave him but slight encourage- 
ment, but his cause was warmly espoused by 
Dr. Evans, who subsequently brought his ap- 
paratus to London, and administered the gas 
before the staff of the Dental Hospital. 

Nitrous oxide is the safest, pleasantest, and 
simplest of all anesthetics hitherto discovered. 
Since its introduction in this country it has 
been used in millions of cases with unvarying 
success and immunity from accident. These 
virtues single it out from all other agents 
employed for the suppression of pain in dental 
operations, while the rapidity with which the 
patient recovers consciousness, and the absence 
of the disagreeable after-effects which follow 
the inhalation of chloroform, etc., are strong 
evidence of the entire absence of danger in 
the use of gas. 

The administration of nitrous oxide gas is not 


unpleasant to the patient; it is practically in- 
odorous, but lias a slightly sweet taste. No 
feeling of suffocation is felt while breathing it. 
The time occupied in obtaining a complete state 
of insensibility is about two minutes, and the 
duration of the insensibility is about thirty 
seconds to one minute. The patient rapidly 
recovers when the administration of the gas is 
stopped, and as a rule feels none the worse 
for the experience. 

Considerable improvements have recently been 
made in the apparatus for the administration of 
gas, and modifications have been introduced for 
continuing its administration through the nose 
while the operation on the mouth is in progress, 
thus considerably lengthening the period of 
insensibility available, while a similar result 
is obtained by the administration of a mixture 
of nitrous oxide gas and oxygen, with the 
additional advantage that the resulting anes- 
thesia is much quieter. 

Patients frequently suffer from toothache for 
several days, losing their rest night after night, 
and at times even abstaining from food owing 
to the increased pain caused by eating. Finally 
in a fit of desperation, they visit a dentist and 
have the tooth extracted under gas ; naturally 
they have fallen into a state of thorough 
physical and mental exhaustion. Upon re- 


covery they usually attribute their collapsed 
state to the after-effects of the gas, not recog- 
nizing that whether they had taken gas or not 
they would have felt equally ill through the 
suffering they had undergone before the aching 
tooth was removed. 

Women, when pregnant, will often suffer 
considerable pain from a decayed tooth under 
the delusion that their condition prohibits them 
having the tooth extracted, and this opinion is 
frequently shared by their medical attendant, 
but all dental authorities agree that pregnancy 
is no bar to the extraction of teeth, if necessary 
to relieve pain, especially under nitrous oxide 
gas. This anesthetic has been frequently used 
even when the confinement was imminent, and 
the tooth removed without injury either to the 
mother or child. 

Use of Local Anesthetics in Dentistry. 

Under nitrous oxide, chloroform and ether, 
the anesthesia is general, that is, the patient 
loses consciousness; but in the minor surgical 
operations only a small part requires to be 
deprived of sensation. From the very nature 
of it general anesthesia has more or less the 
elements of danger, from which local anesthesia 
is free. Many attempts have been made to 
discover a reliable local anesthetic, effectively 


annulling the pain of extraction without render- 
ing the patient insensible. Electricity, ether 
spray, calorific fluid, and chloride of ethyl have 
been tried, and for one reason or another have 
proved failures in actual practice. Eucaine and 
cocaine are the only reliable local anesthetics 
in dentistry, and by the aid of these agents the 
operation of extracting teeth can be performed 
without pain and without loss of consciousness. 


Cocaine is the active principle of a plant Ery- 
throxylon Coca, a native of Peru, the leaves of 
which were found to be in use by the Peruvians 
when that country was conquered by the 
Spaniards nearly four centuries ago. The 
natives ascribed to this plant the property of 
making them insensible to hunger, of adding 
to their strength and vigour, and of relieving 
oppressive respiration during mountain ascents. 
Specimens of the leaves were at various times 
sent to Europe, but the alkaloid was not obtained 
from them till 1860. The discovery was made 
by Neimann in the Vienna laboratory, and it 
was noted at that time that it had the property 
of rendering the tongue temporarily insensible 
at the point of contact, but beyond this its 
power of producing local anesthesia was un- 


known till 1884, when Dr. Koller, of the Vienna 
General Hospital, discovered its virtue in this 
respect. Since that date its use as a local 
anesthetic has spread with great rapidity, par- 
ticularly for operations on the eye, for which 
purpose cocaine has absolutely superseded all 
other agents for the abolition of pain, as the deli- 
cate surface of that organ leads to the immediate 
absorption of the drug. As regards the use of 
cocaine in dentistry, the external application 
of cocaine to the gum around the tooth makes 
the surface of that membrane, after the lapse 
of a few minutes, quite insensible to pricking 
or scratching, and it is frequently thus applied 
on wool with a view, to the mitigation of the 
pain of extraction ; but its effect is then too 
superficial : it is in fact only skin deep. To be 
effectual the drug requires to be applied hypo- 
dermically, i.e. injected beneath the skin. 
When so used, there is first a feeling of 
warmth, then insensibility of the part in the 
neighbourhood of which the injection has 
taken place, permitting the painless extraction 
of the tooth. After the lapse of half an hour 
the normal sensibility returns. Cocaine is thus 
specially useful for the removal of broken-down 
roots and other prolonged operations, for which 
gas is unsuitable, owing to the short duration 
of the insensibility it produces. Cocaine has 


also been used in dentistry to deaden the 
sensitiveness of exposed nerves in preparing 
cavities of teeth previous to filling and, added 
to the devitilizing agent used in the destruction 
of the nerve in a decayed tooth, renders this 
operation perfectly painless. 

The quantity of cocaine used in the extrac- 
tion of a tooth is very small. In large quantities 
cocaine may be poisonous, and several alarmist 
articles have appeared in the daily press, in- 
spired by iujury caused by the use of this drug 
in conjunction with morphia, chloral, etc., by 
habitual drug takers, many of whom consume 
daily quantities far in excess of any amount 
that could possibly be used for the legitimate 
purposes of dental or general surgery. 

A few practitioners have an unreasonable 
prejudice against the use of cocaine owing 
probably to the fact that when it was first 
obtainable in this country, some fifteen years 
ago, the cocaine commercially supplied was 
a crude and impure pharmaceutical product 
which, when dissolved, produced a turbid 
solution in which small fragments of coca 
leaves and stalks, particles of wood, grit, etc., 
were quite visible. The proportion of hygrin 
and other soluble impurities was large. This 
crude cocaine often in stale solutions was exten- 
sively, not to say recklessly, employed in far 


larger doses than would be used to-day, under 
conditions that any one practically acquainted 
with the properties of cocaine would have 
known to have been unfavourable to its 

A number of cases in which alarming 
symptoms appeared were naturally met with, 
and led to the abandonment of the use of 
the agent altogether by some practitioners ; 
but those who persevered in the use of the 
drug soon learnt that the so-called toxic effects 
of cocaine were the result of decomposed solu- 
tions and of impure cocaine, and could be 
avoided by the use of the pure drug freshly 
dissolved in sterilized water. 

To-day cocaine is the most extensively 
employed anesthetic in the surgical treatment 
of the nose, throat, mouth and eyes, and was 
the agent employed in the eye troubles of her 
late Majesty Queen Victoria, and also in the 
operation for cataract performed on the late 
Rt. Hon. W. E. Gladstone. Its employment 
in such cases quite shows that it is a per- 
fectly safe anesthetic in skilled hands ; and 
this is confirmed by the authors' experience, 
which extends over 100,000 administrations for 
the extraction of teeth, etc., in the last fourteen 



Eucaixe is very similar in its properties to 
cocaine. It is a product of the chemical labora- 
tory and is one of those complex chemical bodies 
for which we are indebted to the German 
chemical research. It was discovered in the 
course of experiments to make an artificial 
cocaine. Although a useful anesthetic it is 
practically innocuous even in large quantities; 
it can be used in cases where for any reason 
cocaine is objected to. It is injected into the 
gum in a manner similar to cocaine, and in a 
few moments renders the gum quite insensible, 
permitting the painless removal of the tooth. 
The authors have used eucaine in a large 
number of cases with very satisfactory results. 
It is slightly slower and less reliable in its 
action than cocaine, to which it is preferred 
by many authorities, and like cocaine is exten- 
sively used in dental and ophthalmic surgery. 

Ether Spray and Ethyl Chloride. 

Ether spray was originally introduced by Sir 
B. W. Richardson, and has been used for many 
vears as an obtundent in the extraction of the 
teeth. Pure sulphuric ether is thrown on the 
gum, at the sides of the tooth or teeth to be 



extracted, by a spraying apparatus worked by a 
small foot bellows. The intense cold produced 
rapidly freezes the gum and minimizes the pain 
of the operation. The greatest drawback to 
its employment in dentistry is the fact that the 
first shock caused by the cold spray being 

Fig. 56. — Ether Spra}^ Apparatus. 

thrown in the sensitive tooth is often nearly 
as painful as the actual extraction. Ether 
spray is now superseded by chloride of ethyl, 
which has precisely the same action as ether 
spray and is more effective and less unpleasant 
to the patient. For large and firm teeth it is 
of little use, but where a number of loose teeth 



have to be extracted it proves a very useful 
local anesthetic. It is generally supplied in 
small glass bulbs having a minute opening at 
the top through which, when held in the warm 
hand the ethyl chloride is projected in a small 
stream which is directed on the gum in the 
neighbourhood of the tooth to be extracted. 
The gum becomes blanched and anesthetized, 
and the poignancy of the pain of extraction 
considerably reduced. 

Difficulties and Complications in the 
Extraction of Teeth. 

Like other surgical operations the extraction 
of teeth is at times attended with certain 
difficulties and complications and the healing 
of the gums may not proceed as favourably as 
can be desired. Considerable resistance to 
efforts to effect the removal of a tooth will 
sometimes occur. This is naturally, though 
not always, most frequently met with in those 
of strong physique. Isolated teeth remaining 
long after their neighbours are lost are always 
more difficult to extract than those in series, as 
the bone in the vacant sockets becomes con- 
solidated around them. 

Colyer (Lecturer on Dental Surgery to 


the Charing Cross Hospital) says : — " It may 
perhaps be found impossible to remove the 
tooth. When this is the case it is better to 
dismiss the patient and to make a fresh attempt 
two or three days later. The tooth will prob- 
ably be loose as a result of the inflammation 
and can be easily removed." ! 

The chief causes of undue resistance to efforts 

Fig. 57. — Lower Molar Teeth with roots enlarged by Exostosis. 

of extraction are abnormal density of the 
bone, divergent or twisted roots, or the en- 
largement of the roots of the tooth brought 
about by a disease known as exostosis, which is 
met with very frequently where a gouty ten- 
dency exists. Broken-down teeth and roots 
are obviously the most difficult to extract, but 
with a good set of modern instruments, skil- 
fully employed, the dentist's power to remove 
even the most unpromising-looking roots is sur- 
prising ; but at the same time the occasional 

1 Extraction of the Teeth. Colyer. 


fracture of a tooth and the inability to remove 
the roots at the same sitting are not proofs of 
want of skill. 

Coleman (Examiner in Dental Surgery) 
says: — "A tooth, the attachments of which 
are of greater strength than its own cohesive 
force, must of necessity yield in the latter, 
as will a rotten carrot when attempted to 
be pulled from the ground. In such cases, 
should the remaining portion prove very firm, 
we may have to employ judgment as to the 
length of time for which we are to persevere in 
our efforts to remove it ; it might turn out that 
we are attempting an impossibility, as evi- 
denced at times by the abnormal form of its 
roots or growths upon them. 

" It is extremely unpleasant to send a patient 
away with an aching tooth in situ, but in most 
cases we have found a temporary cessation of 
pain in a tooth, the removal of which has been 
attempted, whilst we may almost for certain 
give the assurance that, should the tooth again 
become tender it will also become somewhat 
loose." 1 

Fracture of the jaw has been known as a 
result of the extraction of a tooth, but with 
ordinary care in performing the operation such 

1 Dental Surgery and Pathology. 



an occurrence is almost impossible except in 
cases where some extraordinary malformation 
of the jaw exists ; but it is probable that the 
alveoli or thin bone surrounding the teeth is 
more or less injured in almost every case of 
extraction, and frequently small pieces come 
away adhering to the root of the tooth. This is 
of little importance, as the whole of this bone 

Fig. 58. — Teetli with curved roots which would cause difficulty 
in extraction. 

is absorbed as the gums fall away subsequent 
to the extraction. Small detached portions 
of the socket should be removed after the 
tooth, but are likely to escape observation 
during the bleeding. These, if allowed to 
remain, may cause some slight irritation, but 
are sloughed off in the course of a few days as 
the socket heals. In the past, when the instru- 
ment known as the key was used in extracting 
teeth, it was not unusual for extensive fractures 
of the alveoli to occur, involving the sockets 
of perhaps two or three teeth in addition to 


the one it was intended to extract; but with the 
modern forceps the risk of alveolar injury is 
reduced to a minimum, and when it does occur 
is so slight that it may be disregarded, except- 
ing so far as the removal of detached fragments 
are concerned. 

Excessive Bleeding after Extraction. 

Prolonged and troublesome bleeding after 
the extraction of a tooth is by no means rare 
and is not necessarily dependent on the extent 
or nature of the wound. Bleeding is as likely 
to occur after a simple extraction as it is after 
the removal of a large and broken-down tooth, 
where considerable laceration of the gums has 
proved unavoidable. It is more frequently 
met with in cases where one tooth has 
been removed than it is after the more ex- 
tensive operations undertaken to clear the 
mouth of teeth and fangs for the reception 
of artificial teeth. That a clean-cut wound 
with smooth edges bleeds more than a lacerated 
one is shown by the fact that a small cut 
inflicted by a razor or sharp knife bleeds pro- 
fusely, while a torn wound of equal size from 
a jagged nail will hardly bleed at all. The 
skill or want of skill with which the operation 
of extraction has been performed has little 


influence on the amount of bleeding that follows. 
The result even o'f a small wound would be 
that the whole of the blood would be drained 
from the body were it not for the tendency of 
the blood vessels to contract and thus prevent 
its escape. The blood itself also has the pro- 
perty of becoming thick (coagulating). These 
two causes combined check the flow of the 
blood from the wound. Where the blood does 
not stop in reasonable time it is principally 
because from some cause the blood vessels fail 
to contract, for frequently in hemorrhage cases 
the blood will form a firm clot in the mouth, 
although the socket itself is filled with fluid 
blood. This want of the power of contraction 
in the smaller blood vessels is frequently a 
personal peculiarity and constitutes what is 
known as the " hemorrhagic diathesis." It is 
advisable where this tendency is known to exist 
to avoid as far as possible extracting the teeth 
and other operations leading to the effusion of 

Troublesome bleeding after the extraction 
of a tooth usually takes the form of secondary 
hemorrhage ; that is, after the operation the 
bleeding ceases and the patient returns home. 
At the expiration of some hours the bleeding 
recommences. Generally the patient wakes up 
in the night and finds his pillow saturated with 


blood which continues to issue in a steady 
stream from the socket. The best course to 
adopt is to return to the dentist who extracted 
the tooth, and as a temporary expedient the 
blood can almost always be checked by soaking 
cotton wool in water and rolling it in a ball 
about the size of a large walnut, and placing 
this over the affected socket in such a manner 
that the wool is firmly held in position 
by the teeth of the opposite jaw when the 
mouth is closed. Of course if the opposing 
teeth are lost a larger piece of wool is 
required, so that the jaw itself produces a 
steady pressure on the socket. A bandage 
passed under the chin and over the head 
sufficiently tight to prevent the mouth being- 
opened is preferable to trusting to the voli- 
tion of the patient. It is advisable to pack 
a piece of dry wool in the socket itself before 
placing the wet ball of wool in its place. It 
is undesirable to give spirits or other stimulants 
to patients suffering from bleeding unless ab- 
solute collapse is threatened, as a slight feel- 
ing of faintness is often a prelude to the 
cessation of the hemorrhage ; and stimulants, 
by reducing the arterial tension, increase the 
flow of blood. Professional assistance should 
be obtained at the earliest possible moment 
unless, of course, this palliative treatment re- 


suits in the stoppage of the bleeding, and even 
then a return to the dentist who extracted the 
tooth, for his advice, is desirable. 

Pain after Extraction. 

After the tooth has been extracted consider- 
able pain may be experienced more or less 
constantly for several days. Coleman says : — 

" We must bear in mind that pain set up 
by a diseased tooth does not always cease with 
its removal, and this is especially the case 
where inflammation has set up in, or extended 
to, its periosteum " (socket lining). 

" The pain after the laceration of membranes 
in such a condition is, we can well comprehend, 
usually very acute and may last for several 
hours, according to the stage of inflammation 
at which the tooth was removed." l 

In badly abscessed cases the discharge may 
continue from the sockets for some days and the 
gum surrounding it looks swollen, unhealthy and 
inflamed, the socket itself being occupied by 
a yellow slough and the breath rendered un- 
pleasant by the discharge. Fomenting the 
mouth with hot solution of carbolic acid (20 
to 30 drops of liquid carbolic acid to a tumbler 
of hot water) has proved the most satisfactory 

1 Dental Surgery and Pathology. 


treatment in the authors' practice. This fo- 
mentation should be persevered with from 10 
to 15 minutes at a time and repeated several 
times daily until the wound heals. 

After a tooth has been extracted the bone of 
the socket can commonly be felt, and much pain 
and inflammation is often caused by the patient 
probing the empty socket with a penknife, pins 
and similar sharp instruments, frequently in an 
uncleanly condition ; or by sticking the tongue 
or finger into the wound, under the delusion 
that there is a piece of the tooth left in. The 
thickness of the gum covering the bone is 
only about equal to that of a piece of wet wash 
leather, and as the socket comes up to the 
necks of the teeth the bone composing it can 
be both seen and felt in the cavity from which 
a large tooth like a molar has been extracted. 

Where the fixing of the jaws (known as 
trismus) exists it is generally very important 
to remove the tooth causing it immediately, as 
there is a great probability of the abscess dis- 
charging through the cheek or under the chin 
and causing an unsightly and permanent dis- 

It is generally possible, by a little manipu- 
lating, to introduce the forceps; while, under the 
influence of nitrous oxide gas, the mouth can 
be opened by a " Mason's gag " and the tooth 


removed without difficulty. The face in these 
cases should not be poulticed, nor is it desir- 
able to wait till the swelling subsides. Where 
the trismus is severe and the inflammation 
runs high, especially if the temperature of the 
patient is raised, every hour the tooth causing 
the trouble is allowed to remain increases the 
danger of the abscess opening externally and 
causing permanent disfigurement. Directly 
the tooth is extracted the pus is discharged 
through the empty socket and the patient re- 
gains his normal temperature in a few hours. 


Necrosis, or death of a portion of the jaw bone, 
may occur after the extraction of a tooth, 
especially in cases where severe inflammation 
and abscess have existed. The disease may be 
confined to the socket of the tooth extracted or 
involve a considerable portion of the jaw bone. 
Sir John Tomes says : — 

"Necrosis of a portion of the bone may 
follow upon the extraction of a tooth, however 
skilfully this has been performed ; and it must 
not be supposed that the operator is to blame 
for the advent of necrosis after the extraction 
of a tooth. 

u The conditions leading to necrosis are, in 


the great majority of cases, developed pre- 
viously to the removal of the tooth, and are 
quite independent of its removal ; the necrosis 
would generally have been quite as sure, and 
perhaps even more extensive, had the tooth 
been left in. There is not the smallest reason 
for believing that the removal of a tooth should 
be deferred because the tissues around it are in 
a state of acute inflammation or suppuration. 
If the tooth be the exciting cause of the mis- 
chief, there is no excuse for delaying its ex- 
traction for a single moment ; and the opinion 
to the contrary, held though it be by a number 
of medical men, is in no degree shared by 
dentists ; and, being based on no evidence 
whatever, must take rank in the category of 
popular errors." l 

The indications that attend necrosis are 
toothache and tenderness in one or more teeth, 
swelling of the face. The gum becomes thickened 
over the diseased part, and of a deep red colour ; 
pus oozes out between the edge of the gum and 
the teeth. After a time the gum separates 
from the bone, which then becomes exposed. 
The discharge becomes very profuse and very 
offensive. After a time, generally a few weeks, 
the dead bone separates from the living and is 
thrown off (exfoliated), and recovery takes place. 
1 System of Dental Surgery. 


Cases of necrosis of the jaws, especially 
when excited by diseased teeth, are generally 
better allowed to remain under the treatment 
of the dental surgeon, as his special study of 
the diseases of the jaws places him in a better 
position to ensure a satisfactory termination 
of the trouble than that occupied by the 
ordinary medical practitioner. 

Premature Loosening and Falling out 
of the Teeth. 

With those whose dental organs have success- 
fully resisted the ravages of decay a gradual 
wasting of the bony sockets, accompanied by 
a corresponding recession of the gum, keeps 
pace with those general changes which attend 
the advance toward old age. The necks of 
the teeth become exposed and the gum ridges 
sink lower and lower till the whole of the roots 
are uncovered and the teeth fall out. 

The ridges of the jaw waste till in some 
instances the upper jaw becomes nearly flat, 
and the lower is reduced to a mere bar of bone 
almost flat topped. This absorption of the 
alveoli, as it is called, is unfortunately not 
only met with in advanced age. It is occasion- 
ally met with in early middle life, and antidates 
by a long period any other sign of approaching 


senility. It is difficult to account in some 
cases for this premature recession of the gum, 
as the inflammation of the gums and tartar 
are both absent, and it is frequently found that 
teeth which have no antagonists in the mouth 
through their opposing teeth in the opposite 
jaw having been lost, are more liable to loosen 

Fig. 59. Fig. 60. 

Fig. 59 shows the gum in its normal state passing up in points 
between the teeth. 

Fig. 60 shows the teeth and gum in an early stage of pyorrhea 
alveolaris ; the delicate festooning of the gum round and between 
the necks of the teeth has been lost. 

than those in full use, and the molars and 
bicuspids will often thus be shed while the 
front teeth remain perfectly firm. When the 
premature loosening of the teeth has occurred 
it is more usual to find that it is the result of 
a disease of a more active and inflammatory 
nature known as pyorrhea alveolaris. 

One of the earliest symptoms of this disease 
is a thickening and rounding of the edge of the 
gum, which ceases to adhere to the neck of the 

As the disease progresses the tooth becomes 


detached from the soft parts to a considerable 
depth, forming a kind of sulcus or pocket con- 
taining a small quantity of pus. 

b c . 

Fig. 61. — The receding gum, showing an early stage of pyorrhea 
alveolaris ; the pocket exists at a c b. 

A ring of dirty green tartar generally sur- 
rounds the neck of the tooth. At the bottom 
of this sulcus an extremely minute exposure of 
the edge of the alveolus exists. This free 

Fig. 62. — A case where the gums and sockets of three front teeth 
are badly affected by pyorrhea alveolaris, while the corresponding 
teeth on the opposite side remain comparatively healthy. 

edge of bone is continually wasting away, 
and thus the socket is ultimately disintegrated 
and the tooth lost. This exposure of the bone 
is shown in fig. 64 slightly exaggerated for the 
purpose of illustration ; the edge of bone 
exposed is really microscopic in its propor- 



The breath is frequently rendered very offen- 
sive, and neuralgic pains are often experienced. 
The gums are inflamed and bleed readily. 
This disease, formerly known as " scurvy of 
the gums/' often arises in otherwise healthy 

Fig. 63. 

Section showing tooth 
and gum in healthy state. 

«, The gum. 

b, The bony walls of 
the socket. 

Fig. 64. 

Section showing tooth and 
gum affected by pyorrhea alveo- 

«, The gum. 

6, The bony walls of socket 
exposed at e. 

c, The rounded and inflamed 
edge of the gum. 

d, The sulcus with a small 
deposit of tartar. 

people who have hardly passed the period of 
middle life, and whose teeth have been excep- 
tionally free from decay. 

The treatment of pyorrhea alveolaris is to 
a great extent palliative and directed to the 
alleviation of the more distressing symptoms 


rather than the cure of the disease. Thus 
astringent mouth washes such as tannin and 
chlorate of potash will reduce the sponginess 
and congestion of the gums, while the use of 
carbolic acid (one drachm to one pint of water) 
or of listerine or other disinfectants, will do 
much to remove the unpleasantness from the 
breath. The progress of the disease can be 
checked by treating the gum round the necks 
of the teeth with iodine, aromatic sulphuric 
acid, cupric sulphate, and other agents ; but 
these powerful escharotics can only be used by a 
dental surgeon. The removal of the tartar is 
a necessary preliminary, and the utmost clean- 
liness must be observed, the teeth being brushed 
frequently with a soft brush. A slight bleeding 
of the gums caused by cleaning, if not excessive, 
can be disregarded, as it probably is beneficial 
rather than otherwise in its effects, and tends 
to reduce the inflammation. 

In an editorial article on pyorrhea alveo- 
laris, The British Journal of Dental Science, 
January 15, 1902, says : " This disease is one 
of the most hopeless conditions of the mouth 
with which we are called upon to deal. At one 
time comparatively rare, it has of late years 
become appallingly common, and it seems to be 
extending its ravages to subjects in early adult 
life, to those whose vitality ought to be in its 


highest vigour. Much has been written con- 
cerning its cause, course, and treatment, but as 
regards the first and last named, we are still 
much in the dark. 

" Strict cleanliness, frequent visits to the 
dentist for the removal of calculus, and brisk 
brushing of the gums undoubtedly retard the 
disease, but as far as our experience goes, any 
relaxation of this discipline is attended by 
fresh onslaughts of the disease. 

" Fixation of the loosened teeth to each other, 
to sound ones, or to an apparatus fixed in the 
mouth, has often been tried, and with varying 
success. But is such treatment the best for 
the health and welfare of the patient ? The 
chief function of the teeth is the masticatory 
one. How is this to be performed when a 
number of loose and tender teeth are joined 
together in this way ? 

" If the teeth have arrived at such a state 
the remedy is extraction, followed by a clean 
healthy gum and a clean healthy palate. Our 
aim ought not to be to preserve the natural 
teeth at any price, but to study the best interests 
of our patients' health, and if the disease is so 
far advanced as to be desperate, the offend- 
ing teeth should be removed, and the mouth 
rendered fit by artificial means to do the work 
for which it is designed." 



Erosion of the Teeth. 

Dental erosion is a disease resulting in the 
wasting away first of the enamel and then of 
the dentine of the tooth, quite distinct from 

Fig. 65. 

caries, as during the progress of the disease 
the affected spot presents a smooth, highly 
polished and sensitive Surface. Erosion may 

Fig. 66. 


appear as irregular shaped excavations in the 
enamel of the teeth (fig. 65). Or it may pass 
in a broad band over several contiguous teeth, 
producing the appearance of the teeth having 
been filed away by a half round file and after- 
wards polished, fig. 66. 

The causes of erosion are obscure ; it is 
possibly in some cases the result of unsuitable 
tooth powders, and in others the acidity of the 
secretions of the mouth exercising a solvent 
action on the surface of the teeth. 

Dental Hygiene. 

It is remarkable that among even well-to-do 
people the necessity for keeping the mouth and 
the teeth in a healthy condition is hardly recog- 
nized, and little cared for. Many times persons 
who are driven to consult their dentist on 
account of an aching tooth are horrified when 
they are told their teeth " are in a dreadful 
state," and resent it. They do not realize that 
of no portion of the human frame can it be said 
more truly than of the teeth that, " as you sow, 
so shall you reap." It is a hard matter to con- 
vince those in robust health that vitiated secre- 
tions, or habits of neglect and carelessness 
entail the decay of their teeth ; while the 
crippled state of the teeth in its turn leads 


<j j 

to a general enfeeblement of health. The rapid 
progress which microscopy and more especially 
bacteriology have made during the last few- 
years has shown us that many diseases are 
communicated from one individual to another 
by means of extremely minute organisms, and 
further physiological chemistry has revealed to 
us that for such micro-organisms to exist, pro- 
pagate and flourish, certain environments are 
requisite. In the mouth, with its constant 
condition of warmth and moisture, the micro- 
organisms are placed in the most favourable 
condition for development and multiplication, 
so that by the neglect of the ordinary laws of 
cleanliness, removal of particles of food about 
and between the teeth, and the omission to use 
frequently an antiseptic wash, the mouth be- 
comes a mere breeding chamber for poisonous 
bacteria and micro-cocci. One often hears it 
said that " bad teeth run in families," and this 
belief, like all fatalistic doctrines, undoubtedlv 
does harm by rendering persons callous, and so 
checking any inclination they might have pos- 
sessed towards careful cleansing of the mouth. 
But the truth of the matter is not accurately 
expressed by this formula, but rather by one 
which declares that an inherited bias towards 
early decay exists in families. In these 
families, if more strenuous efforts are employed 


and greater care taken in the daily ablutions of 
the mouth and teeth after every meal, the 
tendency to the early supervention of caries 
may be, and often is, over-ridden, and the teeth 
remain healthy for a long time. Were it 
possible to keep the teeth perfectly clean, decay 
would never occur, but owing to the form and 
contiguity of the teeth it is utterly impossible 
to cleanse them so thoroughly as to entirely 
dislodge the organisms that originate decay, 
but the nearer we can secure to the mouth 
an ideal state of cleanliness, the greater the 
chance we have of retaining our teeth in a 
healthy and useful condition. 

That cleanliness is a prevention of decay is 
shown by the fact that teeth never decay on 
the cutting edges or surfaces that are sub- 
jected to the friction of the tongue and lips, 
unless some depression or fissure has previously 

Decay always originates between the teeth 
where they come in contact with or close to the 
gum, where, even with the greatest care, some 
small amount of food collects, or mucus can 
gather and decompose and form a nidus for the 
germs of decay to multiply and to attack the 
enamel of the tooth. 

The means by which cleanliness can be 
secured to the mouth is by brushing with a 


brush of suitable hardness not only the fronts, 
but the backs of the teeth, and inside and across 
the grinding surfaces of the molars, at least 
twice a day, using some good tooth paste or 
dentifrice once daily. The frequent passing of 
a thread of floss silk between the teeth will 
clear away many particles that the brush 
cannot reach, while a mouth-wash and gargle of 
listerine is both agreeable and beneficial for its 
antiseptic properties. Simply brushing the teeth 
without using a dentifrice will not prevent them 
becoming discoloured. A tooth powder for a 
healthy mouth should be merely a mechanical 
agent possessing a hardness sufficient for the 
removal of slight accumulation of food, mucus, 
etc., without liability to injure the enamel; it 
should be slightly antiseptic and free from 
acidity and from rough and gritty ingredients 
such as powdered pumice-stone, charcoal, etc. 
Most of the brushes in the market are too large 
and too stiff. Those known as the " Pierrepont 
thorough cleaning " are certainly the most effec- 
tive tooth brushes that can be obtained. They 
are sold in pairs — one brush for the inside and 
another for the outside of the teeth. 

Much harm is frequently done to teeth by too 
vigorous brushing with dentifrices containing 
pumice powder, and cases are occasionally met 
with in practice where the enamel is worn quite 



through, and the dentine exposed. Care is 
necessary in brushing the teeth to cleanse them 
all over rather than in the expenditure of 
muscular force on the front of the mouth alone. 
The upper teeth should be brushed downward 
and the lower upward, as well as from side 
to side. The articulating faces of the teeth 
should be brushed with the same care as other 

Fig. 67. 

surfaces. The best time to use a dentifrice is 
before retiring at night. 

Daring the waking hours the various move- 
ments of the tongue and muscles of the mouth 
in speech and otherwise, the constant salivary 
secretion and the mastication of food, all tend 
to prevent the chemical changes which during 
sleep take place without hindrance. Lime 



water * forms an excellent wash for weak teeth 
showing a tendency to decay, especially in 
young persons and where the saliva has an 
acid reaction. Teeth that become tender to 
the touch round the necks close to the gum are 
rendered less sensitive by the daily use of a 

Fig. 68. 

lime-water mouth wash. Its peculiar value 
consists in the fact that it is alkaline and 
neutralizes the effects of acids. Food may con- 
tain or become acid, or the saliva may be acid, 
a condition that frequently exists where the 
patient is debilitated. 

Those who object to lime water because of 

1 Prepared by placing a piece of freshly slacked lime 
about the size of a hazel nut in a quart bottle of water, 
and shaking. It is then allowed to settle and the clear 
solution used. It must be kept tightly corked. 


its unpleasant taste may remove tliis objection- 
able feature by using with it a few drops of 
eau de Cologne or rose water. A good mouth 
wash for spongy and bleeding gums is made by 
preparing a saturated solution of tannin in 
eau de Cologne, using about half a teaspoonful 
to a wine glass of hot water. 

A teaspoonful of the tincture calendulae to 
a glass of water makes a pleasant mouth wash 
for use after the removal of tartar from the 

Tincture of myrrh, so often prescribed, is 
merely a scent and is absolutely useless as a 
mouth wash. 

Greater care of the teeth is necessary in 
sickness than in health, and irregular and 
crowded or weak teeth need much more atten- 
tion to keep them in a wholesome state than 
those more regularly arranged and better or- 

Dental Dyspepsia. 

" Although dentists are seldom consulted for 
trouble connected with the alimentary tract, 
they yet frequently have opportunities of see- 
ing for themselves the harmful effects pro- 
duced by neglect of the welfare of the teeth. 
The public in general, and the general run of 


the medical profession are scarcely alive to the 
part played by diseased teeth in producing 
indigestion. Where the teeth are imperfectly 
adapted for due mastication, from one cause 
or another, the owner of those teeth will in- 
fallibly suffer in his health. Children who are 
as careless of their teeth as their parents and 
nurses allow them to be — and that too often 
is careless to the verge of utter neglect — 
suffer not only in their childish persons, but 
even pass on to adolescence harmful habits 
formed in early childhood. 

"It is far easier for a child to bolt his food, 
and say nothing about his toothache, than to 
face the supposed horrors of a visit to the 
dentist and all that that entails. The habit of 
bolting is soon acquired, and only broken after 
great trouble and self control. Nor are the 
evils more marked among children. Busy men, 
whose teeth are sound, often through careless- 
ness and hurry scarcely use them at all ; the 
food is bolted and the teeth soon suffer alike 
from an improper performance of function, and 
as a result of chronic congestion, which attacks 
the mucous membrane of the alimentary tract 
from the lips to the stomach and intestines. 
In cases where the teeth are tender mastica- 
tion becomes neglected altogether or is very 
imperfectly performed, and done almost ex- 


clusively on one side of the mouth. We no 
longer seize or tear our food with our teeth, 
but it is necessary for us to crush and grind it 
by lateral and to and fro movements of the 
jaws. Nor can the due amount of crushing or 
grinding be carried out unless these actions of 
the jaws are efficiently performed. The pre- 
sence of fetid material in the mouth, whether 
arising from necrosed stumps or carious teeth, 
is a sure cause of dyspepsia. Dental dyspepsia 
must be recognized and treated by the dentist. 
Times out of number do patients get treated 
by the medical advisers with bismuth or 
alkalies or what not, when a few visits to a 
dentist would have cured the disease. The 
dentist is often asked to remove an aching 
tooth. The most casual glance at the tongue 
convinces him that not only is the aching 
member at fault, but that also many of its 
neighbours are also diseased. Under these 
circumstances the dentist is quite justified in 
promising a cure of the chronic dyspepsia if 
the patient will submit to the removal of the 
offending teeth, and their substitution by arti- 
ficial ones which will be capable of making 
mastication something more than an idle sham. 
The public need educating in this respect, 
and their eyes opened to the casual relation- 
ship in which bad teeth, tender teeth, edentulous 


jaws, and sore mouth, tongue or gums, have to 
dyspepsia." * 

Artificial Teeth : Historical Sketch. 

The history of first efforts to replace the loss 
of natural teeth by artificial substitutes is lost 
in the remote past, for long before the Christian 
era records show that dentures constructed of 
human teeth or the teeth of the lower animals, 
secured in the mouth by gold wires, were in 
use among the Romans ; and in a law promul- 
gated B.C. 450, forbidding the burial of gold 
and jewels with the dead, exception is made in 
the case of gold wires serving to maintain the 
teeth. The museum of the town of Corneto, 
near Civita Vecchia, possesses two small den- 
tures with artificial teeth, one of which was 
found near an Etrurian tomb dating back to 
four or five centuries before the Christian era ; 
the other is from a Roman tomb of the same 
period. These pieces are carved out of the 
teeth of animals and fixed upon a ribbon of 
thin and very soft gold. 

Nevertheless, we do not possess precise data 
relating to the practice of dentistry before 
Cornelius Celsus, who was born tw r enty-five or 
thirty years before our era at Rome, or at 
Verona, and died forty-five or fifty years after 
1 British Journal of Dental Science, 


Christ, and from these early times until the 
eighteenth century probably no material ad- 
vance was made in the construction and adap- 
tation of artificial teeth. 

Pierre Fauchard, in a work published in Paris 
in 1728, was the first to offer any satisfactory 
directions for the construction of plates to 
remedy fissure of the palate (cleft palate), and 
Bourdet, 1757, was amongst the earliest to con- 
struct and adapt whole sets of artificial teeth. 
These sets, composed of ivory and natural teeth, 
soon became useless. The ivory palate being 
acted upon by the fluids of the mouth became 
rough, dark-coloured, and offensive, while the 
natural teeth mounted upon it rotted away with 
great rapidity, necessitating the renewal of the 
denture every twelve or eighteen months. 
These undesirable qualities of ivory and 
natural teeth, foreign to the mouth, led to no 
practical attempt to the manufacture of artifi- 
cial teeth from a mineral compound until the 
year 1774, when a French apothecary named 
Duchateau conceived the idea and lost no time 
in putting it into execution. Taking a dentist 
named Dubois de Chemant into his confidence, 
they repaired to a French porcelain manufac- 
turer, and here, conjointly, the earliest known 
attempt at the manufacture of mineral teeth 
was made. 


The first efforts of Duchateau and Dubois de 
Chemant terminated in failure, although the 
former received the thanks of the French Aca- 
demy of Surgery for his laudable endeavours. 
While Duchateau, presumably chilled by disap- 
pointment, seems to have abandoned the idea 
or considered it too remote to be worth persu- 
ing, Dubois de Chemant preserved it fresh in 
his mind, and in 1787 resumed his experiments 
in the hope of producing some substance imper- 
meable to the secretions of the mouth. With 
official help he obtained the privilege of experi- 
menting in the Government porcelain factory 
of Sevres. Experts in the art gave him the 
full benefit of their experience ; a small furnace 
was built for his use, and after patient investi- 
gation the material was evolved which was 
destined to play such an important part in the 
dentistry of the future. 

The success of Dubois de Chemant provoked 
a storm of ill-favoured opposition. Leading 
French dentists of the day fancied they foresaw 
the enrichment of the inventor at the expense 
of their own practices. The news that an in- 
corruptible artificial tooth had been discovered 
shook the orthodox practitioner with alarm. 
Duchateau, too, who had disagreed with Dubois 
de Chemant, was chagrined at this unexpected 
success, and, joining the attack, brought a law- 


suit against his former partner, claiming priority 
of invention. Dubois de Cliemant began to 
experience that to be renowned is not always to 
be happy, and that to labour for the improve- 
ment of human conditions is far from an un- 
mixed blessing. His grateful confreres harassed 
him with villainies, contrived to destroy his 
furnace in the hope of wrecking any future 
successes, and left nothing undone to secure his 
downfall. Thanks to the good genius which 
seems to have attended him throughout, the 
designs of his enemies were foiled. The case 
for Duchateau broke down. M. Danet, the 
Assayer at the French Mint, who all along took 
a vital interest in the work of Dubois de 
Chemant, was instrumental in obtaining a new 
furnace, which Dubois de Chemant had con- 
structed in his own house. The outbreak 
of the French Revolution drove him from 
France, and coming to England he established 
himself in London some time during the closing 
decade of the eighteenth century in Frith Street, 

Dubois de Chemant left behind him a book 
which he called A Dissertation on Artificial 
Teeth. De Chemant's teeth were not mounted 
in gold or ivory plates, but both teeth and gums 
were in one piece, and composed of the same 
material, but their weight and brittleness were 


obstacles to their general use, and we find later 
that they had fallen utterly into disrepute. 

David Wemyss Jobson, Dentist in Ordinary 
to His Majesty King William IV., in his work 
on the teeth in 1834, says : — 

" Artificial teeth have also of late years been 
made from porcelaneous substances and, under 
the name of ' mineral ' and ' terro-metallic ' 
teeth, have afforded an extensive range for 
empirical deception. The attraction held out 
is, they are alleged to be ' incorruptible,' by 
which term the unwary are entrapped and led 
to believe that teeth of this description are much 
more durable than the old ones (i.e. natural 
teeth artificially used). 

" The very reverse is the case ; for although 
they are not subject to change of colour, yet 
they are in every instance so brittle as to be 
easily broken off on coming in contact with those 
of the opposite jaw. When these mineral or 
china teeth were first introduced, the most ex- 
travagant expectations were then formed from 
them, although few, or rather none, of the 
advantages they were supposed to possess have 
been realized, and they are now considered a 
complete failure. They have never been much 
used by the leading dentists of the day." 

The condition under which a dental practice 
was conducted in 1830 is graphically described 


by Mr. Daniel Corbett, Dental Surgeon, pre- 
siding at the annual meeting of the British 
Dental Association held in Dublin in 1888. 
He stated : " Six weeks was the usual time 
spent in the manufacture of a complete denture 
when working bone and natural teeth. When 
human teeth were in fashion, our supply 
was usually had from the graveyard, and I 
recollect what attention was paid to the grave- 
digger at his periodical visits to my father's 
residence with his gleanings from the coffins he 
chanced to expose in the discharge of his avoca- 
tion. His visits were generally at night, and 
no hospitable duty in which my father might 
chance to be engaged was permitted to interfere 
with the reception of this ever welcome visitor 
into the sanctum sanctorum, of the house." 

The gravediggers every Monday morning 
made their way to the dental depots, each with 
his sack on his back containing the ghastly 
burdens collected during the previous week. 

At this time of day we can scarcely realize 
the horror of the scene of these men bringing 
the jaws which they had turned up in " God's 
acre " in their daily avocation ; but mankind 
required teeth, and to meet the need most of 
those put in the mouth came from the jaws of 
the dead. 

It is said that the Battle of Waterloo fur- 


nished its quota of teeth ; but battles do not 
occur every day, and the bulk of the teeth that 
were used came from the graveyard and the 
hospital, and a lucrative trade it was ! 

Separate mineral teeth, designed to be 
mounted on gold or other plates, which finally 
gave the death blow to the use of the gleanings 
of the graveyard, were the invention of a 
M. Audibran, of Paris, and were introduced into 
this country by Mr. Corbett, senr., and their 
manufacture was taken up by Mr. Claudius 
Ash, of London, in 1837, who rapidly wrought a 
marvellous improvement in their strength and 
beauty, and severed once and for all the grave- 
diggers' connection with the dental surgery. 

The introduction of gold plates for mounting 
artificial teeth early in the last century consti- 
tuted an important advance in the progress of 
prosthetic dentistry, but it had little effect on 
the cost. Artificial teeth still remained luxuries 
that only the very wealthy could afford, but the 
introduction of vulcanite and the general adop- 
tion of mineral teeth in the middle of the cen- 
tury wrought a veritable revolution in dentistry, 
by reducing the cost of production and placing 
artificial teeth of some description within the 
reach of all classes. 


Prosthetic Dentistry. 

The replacement of the lost organs by artificial 
substitutes is one of the most important 
branches of the dentist's art, and many im- 
portant points have to be kept in view. It 
is necessary that he should study carefully the 
requirements of each particularly, for there 
are no two cases alike, and a set of teeth that 
would be well adapted to the mouth of one 
person in point of utility, form and expression, 
would produce great imperfection and even 
distortion in the mouth of another. Hence the 
great importance of the most careful discrimina- 
tion between the various requirements of dif- 
ferent persons in this branch of dental practice. 
The different functions of the natural teeth 
with reference to mastication, enunciation, 
articulation and restoration of the natural 
form and expression of the mouth and face 
should all be fully considered. From the 
taking of the impression, through all the 
different stages of the work to the final com- 
pletion of a denture, various causes may occur 
which might prevent a successful result. 
Therefore, in order to avoid a failure from 
any of these causes, let us look for a moment 
at the acquirements necessary for one to 
possess who is to replace those organs which 


nature had previously formed ; for whatever 
be the mode employed he will have to learn 
that it is the height of art to conceal art. 
This, together with practical utility, should 
be the great point to attain in the construction 
of artificial dentures. To reach these points 
requires the skill and perception of an artist* 
the manipulation and experience of an expert, 
together with thorough mental training and 
scientific research. Some new phase is encoun- 
tered in each succeeding case as, for instance, 
in the length, size, form, position, and adapta- 
tion of the teeth, together with the lighter or 
darker shades and tones of the teeth and gums, 
all of which should be of a character suited 
to the age, complexion, and expression of the 
person for whom they are intended, thus pro- 
ducing one harmonious blending of all the 
features of the face of his patient. A broad 
and square or oval face, a large coarse 
featured man or a delicately organized woman, 
a miss of eighteen or a matron of fifty, a 
brunette or a blonde — these and other varieties 
present as many differing types, with teeth 
corresponding in size, shape, colour, and 
density. If, then, teeth correlated in their 
characteristics to those which nature assigns 
to one class be inserted in the mouth of one 
whose physical organization demands a different 


style, the effect cannot be otherwise than 
displeasing to the eye, whether the observer 
be skilled in perception or only intuitively 
recognizes inharmony without understanding 
the cause. It is quite possible in the adapta- 
tion of artificial teeth for the skilled dentist 
to avoid offending the eye trained to observe 
nature and to add to usefulness the charm of 

The Adaptation of Artificial Teeth. 

The adaptation of artificial teeth is not painful 
nor is it necessary to submit to the removal 
of the teeth that remain in the mouth. The 
lost teeth can be restored without in any way 
interfering with those that remain intact. 
With reference to the extraction of the roots 
of decayed and broken-down teeth, whether 
their removal is necessary depends upon cir- 
cumstances. Certainly where they are abscessed 
and continually emitting an offensive discharge 
their removal is to be desired for salutary 
reasons, entirely apart from the adaptation of 
artificial teeth ; but in many cases healthy roots 
can be treated (as in crown and bridge work) 
and rendered useful as a support to the artificial 

The process of adaptation consists in taking 
an impression of the mouth in a soft plastic 



compound prepared for the purpose. From this 
a facsimile of the jaws is reproduced and the 
artificial teeth are prepared to suit the individual 

Fig. 69. 

peculiarities of the case and have then to be 
inserted in the mouth. They are retained 
securely in their position by atmospheric pres- 
sure (suction) or other means, and can be 
removed and replaced by the patient without 

The time most favourable for the insertion 
of artificial teeth is as soon after the loss of 
the natural ones as the state of the mouth will 
permit before the facial expression has had 
time to alter, as the cheeks and lips are apt 
to become modified by the long absence of teeth, 


so that it is impossible to restore the original 
contour to the face. When the loss is partial 
the restoration of those teeth that have been 
lost is often the best means of preserving the 
rest, as a natural tooth left without an antag- 
onist is apt to protrude from its socket and 
become loose, while the decay or the removal 
of the back teeth results in the destruction of 
the entire set. The cause of this can be seen 
in fig. 69, which represents the teeth closed in 
their natural position, the front upper teeth 
slightly overlapping the lower. The loss of 
the back teeth, by allowing the jaws to ap- 
proach more closely, rapidly forces the upper 
teeth outward, causing them to become elon- 
gated and iiTegular, producing an unsightly 
protrusion of the mouth. 

The lower teeth are forced inwards and also 
loosen and fall out. Figs. 70 and 71 show 
sectional views illustrating the result of the 
loss of the back teeth. 

The teeth also act as conservators of the 
lungs, and organs of voice, preventing the 
breath, in the act of speaking, from being 
exhausted too rapidly. Those who have lost 
their teeth find continued speaking fatiguing, 
as each utterance empties the mouth of air, 
and more rapid breathing is necessary to keep 
up the supply. This induces a feeling of 



distress and is apt to produce a chronic cough, 
especially dangerous in those who suffer from 
weakness of the chest. 

The disfigurement to the personal appear - 

Fig. 70. Fig. 71. 

Fig. 70 shows the central incisors of the upper and lower 
jaws closing normally with the cutting edge of the upper tooth 
slightly overlapping the lower. 

Fig. 71 shows the effect of the loss of the back teeth on the 
incisors. The whole force of mastication falling on the front 
teeth drives the upper outwards thus permitting the jaws to 
approach each other, until the lower tooth bites on the gum at 
the back of the upper. 

ance, although the most obvious, is the least 
important injury inflicted by the loss of the 
teeth, and so fully is this recognized by the 
medical authorities of the present day that 
the restoration of the teeth to a serviceable 


condition by stopping the natural teeth 
where decayed, and by replacing by artificial 
teeth where lost, is regarded as indispensable in 
the treatment of digestive, lung and throat 

The Construction of Artificial Teeth. 

There are several bases used for the con- 
struction of artificial dentures — gold, silver, 
platinum, palladium silver, aluminium, vulcanite 
and celluloid. Which of these bases is best in a 
given case depends upon the nature and extent 
of the loss to be supplied, the age and physical 
characteristics of the patient, and the condition 
of the mouth. No one of these bases is always 
the best, and no authoritative opinion governing 
all cases can be therefore given, although 
for partial cases, especially for young persons, 
a gold denture can be confidently recommended. 
The advantages of gold are that plates can be 
made thinner and smaller than is the case with 
other bases. It is durable and can be re- 
modelled or repaired with the greatest facility, 
should the mouth undergo any alteration. 

Gold is of course the most costly base, and 
thus is placed beyond the reach of many. 
Fortunately other less expensive plates are 
equal to gold in practical utility and durability. 
Dental alloy, known as dental platinum, is a 


base largely used in the construction of artifi- 
cial teeth as a substitute for gold. It is com- 
posed of an alloy of platinum and silver, but 
owing to the largely increased price of pure 
platinum it is not now materially cheaper than 
gold. Palladium, formerly extensively used, 
but displaced by dental alloy, has lately been 
re-introduced ; it is of a silvery grey colour 
and does not corrode in the mouth. Silver is 
unsuitable for the construction of artificial 
teeth, as it blackens and corrodes in the mouth, 
owing to its being acted upon by the sulphur 
existing in the saliva. 

Attempts have been made to adapt aluminium 
to the mouth, but, owing to its softness and to 
the difficulty of soldering it, without practical 
success. It is used in conjunction with vul- 
canite, but it is very uncertain in its behaviour 
in the mouth, sometimes lasting without 
appreciable change for years, while in other 
cases it becomes corroded and roughened 
and wastes away with great rapidity. This 
wasting is probably the result of a slight con- 
tamination with antimony, which exists in much 
of the aluminium sold as "pure." The great 
recommendation possessed by aluminium is its 
lightness, but its softness prevents it displacing 
the more expensive metals in the dental labora- 



There are some cases where the gums and 
bone (consequent upon the loss of teeth, as in 
fig. 73) have entirely receded. In such instances 

Fig. 72. 

Fig. 73. 

Fig. 72. — The lower jaw of an adult, with the teeth and sockets 
in their normal state. The dotted line shows the extent to 
which the bone falls away after the loss of the teeth. 

Fig. 73. — The same jaw after the teeth have been lost and the 
sockets have fallen away, causing the recession of the gums. 

gold would be insufficient, as a material resem- 
bling the gum is requisite, possessing such 
qualifications of lightness and durability that it 
can be recommended to restore the sunken 



gums and return to the face the natural con- 
tour. This is best effected by the improved 
form of vulcanite, now in use because it is 
imperishable, and affords absolute resistance to 
the action of the acids, and is consequently not 
liable to corrode with the saliva. Its inherent 
toughness, firmness, tenacity and fine texture 

Fig. 74. — Vulcanite suction, upper set of teeth, a, vacuum 

make it peculiarly adapted for suction ; it is 
not likely to break, wear away, nor become 
rough, and is susceptible of an elegant finish. 
It forms one undivided piece of mechanism, 
without seams or crevices for the lodgment of 
secretion, thus securing purity to the mouth. 
To reduce the vulcanite to a hard substance 
when it has been moulded to the form required, 
steam pressure is used, which converts it into a 
perfectly compact substance as strong as metal. 
It frequently occurs that after going on 
without giving trouble for some years, the 
natural teeth of an individual fail from one 


cause or another and are lost in rapid succes- 
sion, often at intervals of a few months, neces- 
sitating the addition of new teeth to the artifi- 
cial denture and the ultimate renewal of the 
case is required at a much earlier date than it 
would have been had the mouth been in more 
stable condition. 

Vulcanite is generally the best base to use 
under these circumstances, as it is more easily 
repaired and altered than any other material. 
It affords greater support to loose and shaky 
teeth, and it is less costly should it be imperative 
to replace it by a new case. Artificial dentures 
are also constructed of combinations of gold or 
platinum with vulcanite. The metal is fre- 
quently worked up in the palate to strengthen 
and stiffen the vulcanite plate. Thus used, the 
gold or platinum adds materially to the dura- 
bility of the case, and enables the practitioner 
to make a thinner and slighter denture than 
could be otherwise trusted to. Another form 
of combination work is where the teeth are 
mounted on vulcanite attached to a gold or 
platinum plate. This form of work is rarely 
to be recommended, as it makes a very heavy 
case and more costly than vulcanite, and abso- 
lutely inferior in practical utility, while it is 
difficult to repair, because in the event of the 
metal plate requiring to be soldered the heat 



employed destroys the vulcanite to which the 
teeth are attached, and therefore necessitates 
remodelling the case should the slightest repair 
be required to the plate. 

Although lightness is a usual desideratum in 
a denture it is not always so, as a small increase 
in the weight of a lower case occasionally affords 

Fig. 75. — Full set of artificial teeth fitted with springs. 

valuable aid in overcoming the resistance of the 
muscles of the cheeks and tongue, and in enabling 
the case to be retained with comfort without 
attachments to the remaining teeth, or the use 
of spiral springs, by the force of gravity alone. 
This extra weight may be obtained by inserting 
a core of metal in the centre of the vulcanite, 
or by constructing what is known as a " cast 
metal denture." These dentures are cast in 
one piece from an alloy of tin, silver and gold, 
which does not deteriorate or discolour in the 


mouth. It is strong and takes a fine polish, 
and reproduces the most delicate rugae of the 
models, thus producing a comfortable and an 
accurately fitting case. The extra weight of 
these dentures causes no discomfort after the 
first few hours. 

Difficulties are sometimes met with, especially 
in cases where a full upper and lower set are 
worn, in retaining the plates in position during 
mastication, when a disagreeable noise is occa- 
sioned by the teeth striking each other in the 
act of eating. The addition of a pair of spiral 
springs to the denture will generally remedy 
these defects and add materially to the comfort 
of the patient. Care must of course be taken 
that the springs do not project and chafe the 
mucous membrane of the cheeks. Springs are 
not often required, but where a suction case 
cannot be successfully worn they form a valu- 
able means of retaining the artificial teeth in 

Crown and Bridge Work. 

"American Dentistry " (?) 

Artificial teeth may be adapted to the mouth 
on the suction principle by a closely fitting, 
skilfully adapted plate, to which the wearer in 
a few hours becomes perfectly accustomed, or 



on the crown and bridge principles, by which the 
artificial teeth are attached to the roots that 
remain in the mouth. 

Crown work is the process of attaching arti- 

Fig. 76. — a a, Decayed teeth ; b b, gold caps ; oc, decayed 
teeth with the gold caps fixed. 

ficial crowns to badly decayed teeth, or to roots. 
There are a number of kinds of crowns used. 
Those intended for teeth in the anterior part of 

A B 

Fig. 77. — a, Single front tooth crowned; b, artificial crown 
before fixing on the root. 

the mouth are of porcelain, or have porcelain 
facings, while those employed for back teeth 
alone are commonly made of gold only. 

I 62 


The latter class are caps of gold, which com- 
pletely envelop and enclose the crown of the 
tooth, and they are used in those cases in which 
decay has so wrecked the tooth that a filling 
would fail to preserve it in a satisfactory con- 

Surrounded by its gold cap the tooth cannot 
come into contact with foreign substances, so 
that it is almost impossible for decay to recur. 

Fig. 78. 
Fig. 78 shows a case where four front teeth are missing and 
the stumps of the central teeth remaining. 

For front teeth, crowns with porcelain facings 
are employed to prevent the unsightly appear- 
ance of such an apparent mass of metal. The 
porcelain facing gives to the tooth a natural 
appearance. Formerly the work of crowning, 
which demands great skill and discrimination, 


1 6? 

was confined mainly to the back teeth ; but the 
modern dentist, having improved methods of 
manipulation, successfully operates on any tooth 
if it have but roots which are firmly embedded 
in the jaw. 

Bridge Work. — When there are two or more 

Fig. 79. 

Fig. 79 illustrates four artificial teeth constructed for the 
above mouth on the crown and bridge principle, the plate being 
entirely dispensed with. 

sound roots or teeth, with space from which 
teeth have been lost between them, it is possible 
to supply the missing teeth by constructing a 

Fig. 80. 

Fig. 80 shows the appearance of the same mouth with the 
denture in position, the four lost teeth being perfectly restored. 

bridge of crowns across the vacancy. The 
crowns are soldered to each other, the terminal 



ones being firmly attached to the sound teeth or 
roots in such manner that each of the inter- 
mediate crowns occupies the space of a missing 

Fig. 81. — Model of case when six front teeth are lost. The 
stumps of the canines remain. 

tooth. They may be constructed with a porce- 
lain facing, so that the whole work shall present 
to the observer a most natural appearance. 

Fig. 82.— Six front teeth prepared for the above case to be 
attached to canine roots 

There are a variety of methods for constructing 
these bridges, each excellent in itself, and each 



Fig. 83. — The same case placed in the mouth ; there being no 
plate the palate is uncovered. 

Fig. 84: 

Fig. 84 illustrates a case where four side teeth are lost and a 
denture constructed to fit attached by a crown covering the last 
molar, and a cap fitting the root of the canine or eye tooth. 


specially adapted to some particular class of 

In ordinary bridge work the denture is im- 
movably fixed to the roots or teeth that remain, 
but artificial cases can be constructed of great 
strength and durability, easily removable from 

Fig. 85.— Showing a gold case made in the ordinary method, 

Fig. 86. — Gold case for the same mouth, made as a removable 
bridge case. 

the mouth for purposes of cleaning, etc., and 
yet possessing the advantages of bridge work 
as far as the absence of plate is concerned. 

Illustrations of these removable bridge or 
skeleton cases, and of ordinary suction cases 
constructed for the same mouth show at once 


the difference between the two methods of 
fixing artificial teeth. 

Bridge work has been condemned by many 
dentists of high standing because it has been so 
much abused through its improper use. Some 
practitioners, from a mistaken enthusiasm have 

Fig. 87. — Ordinary suction case. 

Fig. 88. — Removable bridge case for same mouth. 


inserted bridges upon insecure or diseased roots, 
with the natural consequence of their early 
failure. Others have not hesitated to sacrifice 
good and serviceable teeth for the purpose of 
putting in bridges. All these possible abuses do 

1 68 


not excuse the wholesale denunciations of that 
which is proper and correct practice. As well 
might one condemn the filling of teeth because 
poor work is sometimes done. One of the most 
attractive features of this kind of work is, that 
when properly made and inserted the patient 

Fig. 89. — Ordinary gold dentur< 

Fig. 90. — Removable bridge denture. 

soon loses all consciousness of its artificiality. 
The crowns and teeth, being attached to natural 
roots and immovable, approach more nearly to 
the natural organs, and the patient suffers less 
discomfort than from any other artificial sub- 
stitutes. Crown and bridge work has been ex- 
tensively advertised as American dentistry, but 
every dentist knows there is nothing in Ameri- 
can dentistry to render it different from that 


practised in any other country, and that to 
speak of American dentistry is as absurd as to 
talk of American medicine or surgery, or 
American astronomy or any other science. 
Modern dentistry, like every art based on 
science, owes its perfection to the work of men 
of every nationality. No real man of science, 
and no respectable practitioner of any nation- 
ality keeps his knowledge secret — to profess to 
do so marks a man as a pretender or quack. 
Dental science and art cannot be more properly 
called American than German, French or 


Abnormally developed teeth, 

Abrasion of teeth, 131. 
Absorption of the roots of 

temporary teeth, 47. 
Ac ate inflammation of gums, 

Aliment, 23. 
Alimentary canal, 21. 
Alveolar abscess, 85. 

,, ,, hemorrhage, 

,, inflammation of, 

,, absorption of, 
Amalgams, use of for stop- 
ping, 40, 93. 
" American dentistry " ? 160. 
Anesthesia, chloride of 
ethyl, 113. 
,, cocaine, 108. 

„ ether spray, 

,, nitrous oxide 

gas, 103. 
,, eucaine, 112. 

Artificial teeth on alumin- 
ium, 155. 

Artificial teeth on cast metal 

base, 159. 
,, ,, on dental 

alloy, 155. 
„ „ on gold, 154. 

„ ,, on palladium, 

,, ,, on platinum, 

„ ,, onsilver,155. 

Astringent mouthwash, 129. 

Bleeding following extrac- 
tions, 118. 
Brushes, tooth, 13, 130. 

Canines, irregularities in. 
,, permanent, 48, 72. 
,, temporary, 34, 71. 
Capping teeth. 161. 
Carbolic mouth wash, 129. 
Caries, 70. 

M toothache in, 77, 78, 
excitino- causes of. 
„ predisposing causes 
of, 70. 




Cementum, 69. 
Clironic alveolar abscess, 90. 
Cocaine, use of, 108. 
Crown and bridge work, 160. 

O 7 

Crowns, gold, 161. 

Decay of teeth, the causes of, 

Deciduous teeth, 32. 
Defects in formation of 

teeth, 70. 
Dental deformities, 53. 

,, exostosis, 115. 
Dentifrice, 135. 
Dentition, first, 31. 

„ second, 41. 

Destruction of pulp, 82. 
Diet for children, 26. 
Difficult dentition, 35. 
Difficulties in extracting 

teeth, 114. 
Digestion, 14, 20. 
Dyspepsia, dental, 138. 

Enamel, description of, 68. 
,, fissures in, 71, 76. 
Eruption of temporary teeth, 
,, permanent teeth, 
41, 49, 57. 
Ether spray, 113. 
Ethyl, chloride of, 113. 
Eucaine, 112. 

Exostosis (enlargement of 
roots), 115. 

Extraction of teeth, diffi- 
culties met with in, 114. 

Filling, operation of, 40, 92. 
Fissures a cause of caries, 

71, 76. 
Food, relations of the teeth 
to, 26. 
,, starchy, injurious to 
young children, 26. 
Fractured teeth, 116. 

Gas, nitrous oxide, 103. 
Glands, salivary, 15. 
Gold stopping, 93. 
„ crowns, 161. 
Gold plate, artificial teeth 

on, 154. 
Green discoloration of teeth, 

Gum-boil, 85. 
Gutta percha, displacement 

of teeth caused by the 

use of, 95. 
Gutta percha filling, 94. 

Hemorrhage after extrac- 
tion, 118. 
Hemorrhagic diathesis, 118, 
Honeycombed teeth, 70. 

Inflammation of pulp, 82. 

,, ,, a 1 v e olar 

m e m - 



Incisor teeth, 32, 

36, 48, 55. 

Infancy, food 

during, 26. 



Irregularities of teeth, 51. 



,, causes 
of, 52. 



„ correc- 
tion of, 

Jaws, necrosis of, 123. 

Lancing the gums, 36, 50. 
Local anesthesia, 107. 

Malposition of teeth, 55, 58, 

Mastication of food, results 

of imperfect, 12. 
Metallic fillings in caries, 

Mouth washes, 129, 137, 138. 

Pain in teeth, 77, 78, 82. 
Periodontitis, 85. 
Permanent teeth, eruption of, 

41, 49. 
Platinum, artificial teeth on, 

Premature extraction of the 

temporary teeth, 52, 57. 
Prosthetic dentistry, 148. 
Pulp, description of, 67. 

,, exposure of, 82. 
Pulpitis, 82. 

Recedence of gums, 125. 
Regulation of the teeth, 54. 
Roots of teeth, irregularities 
of form, 115, 117. 

Necrosis of the jaws, 123. 
Nerves of the teeth, 78. 
Neuralgia, 82, 123. 

Saliva, 15. 

Salivary calculus, 13, 97. 

„ glands, 15. 
Shedding of temporary teeth, 

47, 71. 
Silver plate, artificial teeth 
on, 155. 
Offensive breath, 10, 99, 101, Sixth-year molars, 41. 

121, 128. Sloughing of the gum, 123. 
„ discharges from Stumps, removal of, 102. 

the gum, 127. Springs for artificial teeth, 

„ secretions of the 159. 

mouth, 15. Suction dentures, 151, 157. 

Supernumerary teeth, 52. 
Palladium, artificial teeth Sympathetic pain arising 

on, 155. 

from teeth, 81. 



Tartar, 13, 97. 

Tee tli, arrangement of, 31, 
,, artificial, 150. 
,, as conservators of the 

lungs, 152. 
„ brushes, 13. 

Teeth, temporary, premature 
extraction of, 52, 57, 
Thumb sucking, results of, 

Toothache, cause of, 82, 123. 
„ treatment of, 77, 

78, 82, 85. 

care of, 132. 

eruption of permanent, Tooth powder, 135. 

41, 49, 57. 
eruption of temporary, Vulcanite, artificial teeth on, 

32. 15G. 

extraction of, 114. 
honeycombed, 70. Wisdom teeth, eruption of, 

in sickness, 18. 


Butler & Tanner, The Selwood Printing Works, Frome, and London. 



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